MEDICARE: MRS. SUSAN B MARSHALL 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	363AM0700X	Medical Physician Assistant	PA10418	TX
2	363AM0700X	Medical Physician Assistant	0010-00700	NC
3	363A00000X	Physician Assistant	0010-0700	NC

General Provider Information

NPI Number	:	1114094679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN B MARSHALL PA-C

Provider Business Mailing Address
First Line	:	6104 FAYETTEVILLE RD STE 101
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6283
Country	:	US
Telephone Number	:	919-908-6446
Fax Number	:	919-381-5020

Provider Business Practice Location Address
First Line	:	6104 FAYETTEVILLE RD STE 101
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6283
Country	:	US
Telephone Number	:	919-908-6446
Fax Number	:	919-381-5020

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/25/2022

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