Healthcare Provider Details

I. General information

NPI: 1598396491
Provider Name (Legal Business Name): SUSAN DUNPHY PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13805 WEST HATTON PLACE
NEWBURG MD
20664
US

IV. Provider business mailing address

PO BOX 12
MOUNT VICTORIA MD
20661-0012
US

V. Phone/Fax

Practice location:
  • Phone: 301-717-9146
  • Fax:
Mailing address:
  • Phone: 301-717-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0000812
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: