Provider Demographics
NPI:1326176090
Name:PIOTTI, SUSAN A (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:PIOTTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4526
Mailing Address - Country:US
Mailing Address - Phone:800-395-0232
Mailing Address - Fax:207-873-2385
Practice Address - Street 1:80 MAIN STREET
Practice Address - Street 2:
Practice Address - City:UNITY
Practice Address - State:ME
Practice Address - Zip Code:04988-0000
Practice Address - Country:US
Practice Address - Phone:207-948-2100
Practice Address - Fax:207-948-3018
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH36301Medicare UPIN