Provider Demographics
NPI:1013985860
Name:PABST, SUSAN JANIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANIS
Last Name:PABST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 TATE BLVD SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1384
Mailing Address - Country:US
Mailing Address - Phone:828-485-2707
Mailing Address - Fax:828-485-2708
Practice Address - Street 1:1501 TATE BLVD SE
Practice Address - Street 2:SUITE 202
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1384
Practice Address - Country:US
Practice Address - Phone:828-485-2707
Practice Address - Fax:828-485-2708
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600667208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2225924BOtherMEDICARE INDIVIDUAL PTAN
NC8964751Medicaid
NC2225924BOtherMEDICARE INDIVIDUAL PTAN