Provider Demographics
NPI:1770503013
Name:EMAUS, SUSAN P (PA C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:EMAUS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COLLYER STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-793-7191
Mailing Address - Fax:401-793-7200
Practice Address - Street 1:208 COLLYER STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-793-7191
Practice Address - Fax:401-793-7200
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00043363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI979004003Medicaid
RI979004003Medicaid
RI7008093Medicare ID - Type Unspecified