Provider Demographics
NPI:1609854041
Name:SUZIO, KATHRYN (PA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:SUZIO
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 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-6394
Mailing Address - Fax:860-344-6748
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:AMELIA BALDWIN, ENROLLMENT COORDINATOR
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3654
Practice Address - Country:US
Practice Address - Phone:860-358-6394
Practice Address - Fax:860-344-6748
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000487363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical