Provider Demographics
NPI:1710919873
Name:MARTIN, SUSAN E (CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MARTIN
Other - Last Name:KNAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7800
Mailing Address - Fax:717-812-7811
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-7800
Practice Address - Fax:717-812-7811
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008441L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA275391OtherUNISON-YHCHC
PA3008501OtherCAPITAL BLUE CROSS-WMG
PA20019452OtherAMERIHEALTH MERCY-WMG
PA138302OtherUNISON-WMG
PA39285OtherJOHNS HOPKINS
PA2103182OtherMAMSI-WMG
PA1527027OtherGATEWAY-WMG
PA001942621Medicaid
PA100455OtherGEISINGER
PA7434923OtherAETNA
PA1527027OtherGATEWAY-WMG
PA20019452OtherAMERIHEALTH MERCY-WMG
PA3008501OtherCAPITAL BLUE CROSS-WMG