Healthcare Provider Details

I. General information

NPI: 1447253679
Provider Name (Legal Business Name): SUSANNE T WOODLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILIP DR STE 111
OLNEY MD
20832-1503
US

IV. Provider business mailing address

7 GRANITE PL UNIT 416
GAITHERSBURG MD
20878-6594
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-6500
  • Fax: 301-774-5461
Mailing address:
  • Phone: 301-602-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberD0050262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: