Provider Demographics
NPI:1477649358
Name:GALVIN, SUSANNE A (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:A
Last Name:GALVIN
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 1:2960 N CIRCLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-634-8891
Mailing Address - Fax:719-634-1897
Practice Address - Street 1:2960 N CIRCLE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-634-8891
Practice Address - Fax:719-634-1897
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1190363AS0400X
COPA.0001190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ42563Medicare UPIN
CO801721Medicare ID - Type UnspecifiedPERSONAL NUMBER
CO800124Medicare ID - Type UnspecifiedGROUP NUMBER