Provider Demographics
NPI:1508832783
Name:KEWER, SUSAN D (PA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:KEWER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:5899 BREMO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1935
Practice Address - Country:US
Practice Address - Phone:804-288-8512
Practice Address - Fax:804-288-4552
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
VA0110001950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508832783Medicaid
VAP00630298OtherRAILROAD MEDICARE
VA1508832783Medicaid
VA0472640004Medicare NSC