Provider Demographics
NPI:1376533661
Name:ALLARD, SUSAN TABAR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TABAR
Last Name:ALLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:ALLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6136 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2610
Mailing Address - Country:US
Mailing Address - Phone:703-866-3131
Mailing Address - Fax:703-866-3133
Practice Address - Street 1:6136 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-866-3131
Practice Address - Fax:703-866-3133
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281211207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 0001Medicare UPIN