Healthcare Provider Details

I. General information

NPI: 1841496064
Provider Name (Legal Business Name): SUZANNA E. MARTIN M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR SHADY GROVE ADVENTIST HOSPITAL
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

9901 MEDICAL CENTER DR PEDIATRIC EMERGENCY DEPARTMENT
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 240-826-6610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0073822
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD0073822
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: