Provider Demographics
NPI:1417990839
Name:FERRERO, SUSAN B (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:FERRERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SEA MOUNTAIN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 SEA MOUNTAIN HWY STE B
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8161
Practice Address - Country:US
Practice Address - Phone:843-399-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC363A00000X
CT001700363AS0400X
SC2604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1255448155OtherGHMC GROUP NPI PROVIDER I
CT2V6305OtherHEALTH NET
CT9763814OtherCIGNA
CT290001700CT01OtherBCBS
CTC01373OtherGHMC GROUP MEDICARE ID
CT101700OtherCONNECTICARE
CTQ69653Medicare UPIN
CT290001700CT01OtherBCBS