Healthcare Provider Details

I. General information

NPI: 1306484902
Provider Name (Legal Business Name): SUZETTE MARIE HUGUENIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZETTE MARIE HUGUENIN PHD

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KENNEDY KRIEGER INSTITUTE 707 N BROADWAY RM 526
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

KENNEDY KRIEGER INSTITUTE 707 N BROADWAY RM 526
BALTIMORE MD
21205-1832
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-2782
  • Fax: 443-923-2781
Mailing address:
  • Phone: 443-923-2782
  • Fax: 443-923-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number2005072B
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number2005072W
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: