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General NPI Number Information
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NPI Number | 1396082400
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Entity Type | Individual
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Provider Name | SUZANNE LOUISE LATIMER PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 951 ALBANY SHAKER RD
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City | LATHAM
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State | NY
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Zip | 12110-1452
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Country | US
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Telephone | 518-220-2022
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Fax | 518-220-9263
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Provider Business Mailing Address
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Address Line | 951 ALBANY SHAKER RD
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City | LATHAM
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State | NY
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Zip | 12110-1452
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Country | US
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Telephone | 518-220-2022
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Fax | 518-220-9263
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001240
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License Number State | NY
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