Healthcare Provider Details

I. General information

NPI: 1093943813
Provider Name (Legal Business Name): HEATHER ADINA SUSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST STE 4226
TOWSON MD
21204
US

IV. Provider business mailing address

6701 N CHARLES ST # 4226
TOWSON MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2202
  • Fax: 410-337-5068
Mailing address:
  • Phone: 201-745-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA09162900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0083956
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: