Provider Demographics
NPI:1932492543
Name:GALLOWAY, SUSANN LOUISE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SUSANN
Middle Name:LOUISE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5921 BRACKENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3528
Mailing Address - Country:US
Mailing Address - Phone:443-602-2562
Mailing Address - Fax:
Practice Address - Street 1:425 HOLIDAY DRIVE
Practice Address - Street 2:FOSTER PLAZA 2, WEXFORD HEALTH SOURCES
Practice Address - City:PITTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15220-1839
Practice Address - Country:US
Practice Address - Phone:410-230-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant