Healthcare Provider Details

I. General information

NPI: 1316332828
Provider Name (Legal Business Name): SUSANNA KATHERINE JEURLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10753 FALLS RD STE 225
LUTHERVILLE MD
21093-4597
US

IV. Provider business mailing address

10753 FALLS RD STE 225
LUTHERVILLE MD
21093-4597
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-2848
  • Fax:
Mailing address:
  • Phone: 410-583-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0090081
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: