Provider Demographics
NPI:1669445979
Name:COLLINS, SUSANNE M (PAC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:M
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1414
Mailing Address - Country:US
Mailing Address - Phone:781-280-1683
Mailing Address - Fax:
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:484-565-1044
Practice Address - Fax:484-565-1044
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003607L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35367Medicare UPIN
PA049341Medicare ID - Type Unspecified