MEDICARE: SUSAN D CASPER PA

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	PA00253	RI
2	363A00000X	Physician Assistant	5184	SC
3	363A00000X	Physician Assistant	9118309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30289-8	OTHER	RI	BCBS
3	408463	OTHER	RI	BLUE CHIP

General Provider Information

NPI Number	:	1558466540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN D CASPER PA

Provider Business Mailing Address
First Line	:	5788 ROSWELL RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4904
Country	:	US
Telephone Number	:	800-678-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 DILLON DR
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-1018
Country	:	US
Telephone Number	:	800-678-4611
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	01/06/2026

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Directions to “ SUSAN D CASPER PA” Practice Location

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