Provider Demographics
NPI:1912930298
Name:ABRUZZINO, SUSAN ANNETTE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNETTE
Last Name:ABRUZZINO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1346
Mailing Address - Country:US
Mailing Address - Phone:304-623-7682
Mailing Address - Fax:
Practice Address - Street 1:LOUIS A JOHNSON VAMC
Practice Address - Street 2:1 MEDICAL CENTER DRIVE
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-623-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical