Provider Demographics
NPI:1548246069
Name:FLETCHER, SUSAN H (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:FLETCHER
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 1:1025 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4229
Mailing Address - Country:US
Mailing Address - Phone:860-696-2400
Mailing Address - Fax:860-696-2410
Practice Address - Street 1:1025 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4229
Practice Address - Country:US
Practice Address - Phone:860-696-2400
Practice Address - Fax:860-696-2410
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000412363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1548246069OtherNPI
CTD400083961Medicare PIN
CT1548246069OtherNPI