Provider Demographics
NPI:1851385512
Name:HATHAWAY, SUSAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-929-1195
Mailing Address - Fax:603-929-1196
Practice Address - Street 1:879 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842
Practice Address - Country:US
Practice Address - Phone:603-929-1195
Practice Address - Fax:603-929-1196
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0371363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075895Medicaid
NH3075895Medicaid
ME142350001Medicare ID - Type Unspecified
NH30333592Medicaid
NHAP1839Medicare PIN