MEDICARE: MRS. SUSAN HATHAWAY PA

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	0371	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851385512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN HATHAWAY PA

Provider Business Mailing Address
First Line	:	7 HOLLAND WAY FL 1
Second Line	:
City	:	EXETER
State	:	NH
Zip	:	03833-2997
Country	:	US
Telephone Number	:	603-929-1195
Fax Number	:	603-929-1196

Provider Business Practice Location Address
First Line	:	879 LAFAYETTE RD
Second Line	:
City	:	HAMPTON
State	:	NH
Zip	:	03842
Country	:	US
Telephone Number	:	603-929-1195
Fax Number	:	603-929-1196

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/17/2019

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