Provider Demographics
NPI:1962483016
Name:HACKMAN-QUINTY, SUSAN E (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HACKMAN-QUINTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2599
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2599
Mailing Address - Country:US
Mailing Address - Phone:978-884-0552
Mailing Address - Fax:
Practice Address - Street 1:181 BLUFFTON RD STE G101-102
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6221
Practice Address - Country:US
Practice Address - Phone:843-757-5400
Practice Address - Fax:843-757-2240
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA192848Medicaid
H56266Medicare UPIN
MAA333619Medicare ID - Type Unspecified