Provider Demographics
NPI:1396082400
Name:LATIMER, SUZANNE LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LOUISE
Last Name:LATIMER
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 1:951 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1452
Mailing Address - Country:US
Mailing Address - Phone:518-220-2022
Mailing Address - Fax:518-220-9263
Practice Address - Street 1:951 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1452
Practice Address - Country:US
Practice Address - Phone:518-220-2022
Practice Address - Fax:518-220-9263
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant