Provider Demographics
NPI:1821216078
Name:ALBANOWSKI, SUSAN REBECCA (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:REBECCA
Last Name:ALBANOWSKI
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 1:5432 HIGHFIELDS RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4108
Mailing Address - Country:US
Mailing Address - Phone:540-798-8627
Mailing Address - Fax:
Practice Address - Street 1:16 WALNUT AVE SW
Practice Address - Street 2:SW
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4719
Practice Address - Country:US
Practice Address - Phone:540-345-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001854363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical