Healthcare Provider Details

I. General information

NPI: 1952614075
Provider Name (Legal Business Name): SUSAN KARTIKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW FL 6
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW FL 6
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-6219
  • Fax: 202-741-3219
Mailing address:
  • Phone: 202-677-6219
  • Fax: 202-741-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number267696
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number267696
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD047306
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: