Provider Demographics
NPI:1639168586
Name:ESMOND, SUSAN M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:ESMOND
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 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-394-9355
Mailing Address - Fax:303-388-8564
Practice Address - Street 1:4500 E. 9TH AVE
Practice Address - Street 2:#450
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3933
Practice Address - Country:US
Practice Address - Phone:303-394-9355
Practice Address - Fax:303-388-8564
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59755067Medicaid
CO59755067Medicaid
COCO305360Medicare PIN
CO513888Medicare ID - Type Unspecified
COP00882039Medicare PIN