Healthcare Provider Details

I. General information

NPI: 1730609835
Provider Name (Legal Business Name): SUSAN ELAINE MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN ELAINE THURMAN PA-C

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

2077E RALEIGH RD
HUMMELSTOWN PA
17036-8779
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 443-421-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004166
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059212
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: