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Individual
SUSAN C ANDERSON
Active
Individual
SUSAN C ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
010647
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02923944
—
NY
Enumeration date
07/25/2006
Last updated
04/01/2015
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