Healthcare Provider Details

I. General information

NPI: 1023326337
Provider Name (Legal Business Name): SUSAN DANIELA GUMPEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE STE 5800
FORT MEADE MD
20755-5129
US

IV. Provider business mailing address

2480 LLEWELLYN AVE STE 5800
FORT MEADE MD
20755-5129
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8670
  • Fax:
Mailing address:
  • Phone: 301-677-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD57048
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: