MEDICARE: SUSAN MARIE QUIRK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50000765	OH
2	363A00000X	Physician Assistant	1501132	KS
3	363A00000X	Physician Assistant	0010-08632	NC

General Provider Information

NPI Number	:	1255388930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE QUIRK PA-C

Provider Business Mailing Address
First Line	:	3053 MARTINS POINT RD
Second Line	:
City	:	KITTY HAWK
State	:	NC
Zip	:	27949-3816
Country	:	US
Telephone Number	:	810-278-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 CC CAMP RD
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-8833
Country	:	US
Telephone Number	:	336-530-1031
Fax Number	:	336-530-1032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/16/2025

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Directions to “ SUSAN MARIE QUIRK PA-C” Practice Location

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