Provider Demographics
NPI:1750630414
Name:WHITT, SUSAN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:WHITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7901 DILEY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9612
Mailing Address - Country:US
Mailing Address - Phone:614-920-1000
Mailing Address - Fax:614-920-1007
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-920-1000
Practice Address - Fax:614-920-1007
Is Sole Proprietor?:No
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH1034787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical