Provider Demographics
NPI:1487636361
Name:CARSTATER, SUZANNE MARY (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:CARSTATER
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 1:300 STATE ST STE 301B
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1430
Mailing Address - Country:US
Mailing Address - Phone:814-877-5700
Mailing Address - Fax:814-877-5655
Practice Address - Street 1:300 STATE ST STE 301B
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1430
Practice Address - Country:US
Practice Address - Phone:814-877-5700
Practice Address - Fax:814-877-5655
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001617L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS34871Medicare UPIN
PACA745902Medicare ID - Type Unspecified