Provider Demographics
NPI:1770626517
Name:BAUGHN, SUZANNE (NP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BAUGHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:K
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:195 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1700
Mailing Address - Country:US
Mailing Address - Phone:978-526-4311
Mailing Address - Fax:978-525-2342
Practice Address - Street 1:195 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1700
Practice Address - Country:US
Practice Address - Phone:978-526-4311
Practice Address - Fax:978-525-2342
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP5112Medicare UPIN