Provider Demographics
NPI:1487673372
Name:BROWN, SUZANNE LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LEE
Last Name:BROWN
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 1:501 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-5006
Mailing Address - Fax:304-636-4898
Practice Address - Street 1:501 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-5006
Practice Address - Fax:304-636-4898
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00765363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV765OtherHEALTH PLAN
WV001719255OtherMOUNTAIN STATE BCBS
WVP00328097OtherRAILROAD MEDICARE
WVP00328097OtherRAILROAD MEDICARE