Healthcare Provider Details

I. General information

NPI: 1164954996
Provider Name (Legal Business Name): SUSAN MICHELLE FOLSOM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE WRNMMC
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-0006
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 301-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD472785
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD472785
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberMD472785
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: