Provider Demographics
NPI:1376533661
Name:ALLARD, SUSAN TABAR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TABAR
Last Name:ALLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:ALLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL - CARDIOLOGY DEPT
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060
Mailing Address - Country:US
Mailing Address - Phone:571-231-2006
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL - CARDIOLOGY DEPT
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-0001
Practice Address - Country:US
Practice Address - Phone:571-231-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106081-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 0001Medicare UPIN