Provider Demographics
NPI:1497087597
Name:ADKINS, SUSAN R (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:ADKINS
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:THE HEALING ARTS CENTER, #2
Mailing Address - Street 2:617 FRANKLIN
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1440
Mailing Address - Country:US
Mailing Address - Phone:215-313-2434
Mailing Address - Fax:302-856-2330
Practice Address - Street 1:227 PENNSYLVANIA 100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:160-336-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054229363A00000X
PAOA002472363A00000X
DEC5-0001087363AM0700X
MDC07173363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA241804YEBK - 213827Medicare UPIN