Healthcare Provider Details

I. General information

NPI: 1467465294
Provider Name (Legal Business Name): SUSAN B HURSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW SUITE 251
WASHINGTON DC
20016-3622
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW SUITE 251
WASHINGTON DC
20016-3622
US

V. Phone/Fax

Practice location:
  • Phone: 202-362-9872
  • Fax: 202-362-9874
Mailing address:
  • Phone: 202-362-9872
  • Fax: 202-362-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD19205
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: