Provider Demographics
NPI:1457544256
Name:SUSEN, ANDREW PAUL (PA-C, MSC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PAUL
Last Name:SUSEN
Suffix:
Gender:M
Credentials:PA-C, MSC
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-729-0134
Mailing Address - Fax:
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 23
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-729-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001095363A00000X
MEPA1095363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant