Provider Demographics
NPI:1477522332
Name:SUSANN, PHILIP WILLARD (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:WILLARD
Last Name:SUSANN
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:419 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 FULTON ST
Practice Address - Street 2:111A- CARDIOLOGY
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3879
Practice Address - Country:US
Practice Address - Phone:919-967-0411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant