Provider Demographics
NPI:1669661286
Name:SMITH, SUSANNE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2322 E 22ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3176
Mailing Address - Country:US
Mailing Address - Phone:216-363-2691
Mailing Address - Fax:216-694-4665
Practice Address - Street 1:2322 E 22ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:216-363-2691
Practice Address - Fax:216-694-4665
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50000455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant