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Individual
SUSAN E KELLOGG
Active
Individual
SUSAN E KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
275
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
THREE RIVERS
—
05
—
110123231A
—
MA
01
—
8300457
EVERCARE
—
01
—
970013334
RAILROAD MEDICARE
—
01
—
9900373
FALLON COMMUNITY HEALTH P
—
01
—
AP0289
MEDICARE B
—
Enumeration date
01/18/2006
Last updated
03/09/2018
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