MEDICARE: MS. SUSAN SLEIGHTER WILFAHRT 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	363A00000X	Physician Assistant	202	MA

General Provider Information

NPI Number	:	1396815916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN SLEIGHTER WILFAHRT PA-C

Provider Business Mailing Address
First Line	:	66 LINCOLN AVE
Second Line	:
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2028
Country	:	US
Telephone Number	:	978-468-6523
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 CONGRESS ST
Second Line	:	CHARTER PROFESSIONAL SERVICES
City	:	SALEM
State	:	MA
Zip	:	01970-5529
Country	:	US
Telephone Number	:	978-741-1200
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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