Provider Demographics
NPI:1336196658
Name:IRETON, SUSAN CRAGIN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CRAGIN
Last Name:IRETON
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 1:1130 N CHURCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1008
Mailing Address - Country:US
Mailing Address - Phone:336-375-2300
Mailing Address - Fax:336-375-2313
Practice Address - Street 1:1130 N CHURCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1008
Practice Address - Country:US
Practice Address - Phone:336-375-2300
Practice Address - Fax:336-375-2313
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101205363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R82583Medicare UPIN
NC2755748CMedicare PIN
NC2755748AMedicare PIN
NC2755748BMedicare PIN