Provider Demographics
NPI:1639270309
Name:GARTLAND, SUSAN (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GARTLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-3043
Mailing Address - Country:US
Mailing Address - Phone:207-483-4502
Mailing Address - Fax:207-483-2525
Practice Address - Street 1:50 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643
Practice Address - Country:US
Practice Address - Phone:207-483-4502
Practice Address - Fax:207-483-2525
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant