Healthcare Provider Details

I. General information

NPI: 1720203284
Provider Name (Legal Business Name): SUSAN GANI KOZAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN GANI MD

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 WOODMONT AVE SUITE 1101
BETHESDA MD
20814-3002
US

IV. Provider business mailing address

14225 POPLAR HILL RD
DARNESTOWN MD
20874-3562
US

V. Phone/Fax

Practice location:
  • Phone: 301-208-0930
  • Fax:
Mailing address:
  • Phone: 240-683-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0062508
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: