Provider Demographics
NPI:1174557680
Name:HACKWORTH, SUSAN LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:HACKWORTH
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 1:3720 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3520
Mailing Address - Country:US
Mailing Address - Phone:412-882-9455
Mailing Address - Fax:412-884-6149
Practice Address - Street 1:3720 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3520
Practice Address - Country:US
Practice Address - Phone:412-882-9455
Practice Address - Fax:412-884-6149
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA 002831L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant