Healthcare Provider Details

I. General information

NPI: 1750365011
Provider Name (Legal Business Name): SUSAN M ALLIG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20680 SENECA MEADOWS PKWY STE 200
GERMANTOWN MD
20876-7029
US

IV. Provider business mailing address

9407 CHADBURN PL
MONTGOMERY VILLAGE MD
20886-4031
US

V. Phone/Fax

Practice location:
  • Phone: 301-701-6900
  • Fax: 703-742-9081
Mailing address:
  • Phone: 240-620-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR065088
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: