Provider Demographics
NPI:1790870244
Name:ZEPKA, SUSAN G (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:ZEPKA
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 1:725 NORTH ST.
Mailing Address - Street 2:BERKSHIRE MEDICAL CENTER EMERGENCY DEPT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2175
Practice Address - Street 1:725 NORTH ST.
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER EMERGENCY DEPT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:413-447-2175
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S61326Medicare UPIN
MAAP0883Medicare ID - Type Unspecified