Healthcare Provider Details

I. General information

NPI: 1487624748
Provider Name (Legal Business Name): SUSAN J. SALANDER P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD SUITE 2D
LEOMINSTER MA
01453-2253
US

IV. Provider business mailing address

100 HOSPITAL RD SUITE 2D
LEOMINSTER MA
01453-2253
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-0582
  • Fax: 978-534-6519
Mailing address:
  • Phone: 978-534-0582
  • Fax: 978-534-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number522
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: