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General NPI Number Information
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NPI Number | 1104009562
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Entity Type | Organization
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Legal Business Name | SUSANNE WOODLAN, M.D., LLC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 18111 PRINCE PHILIP DR SUITE 111
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City | OLNEY
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State | MD
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Zip | 20832-1513
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Country | US
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Telephone | 301-774-6500
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Fax | 301-774-5461
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Provider Business Mailing Address
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Address Line | 18111 PRINCE PHILIP DR SUITE 111
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City | OLNEY
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State | MD
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Zip | 20832-1513
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Country | US
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Telephone | 301-774-6500
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Fax | 301-774-5461
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUSANNE T WOODLAN
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Credential | MD
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Telephone | 301-774-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0050262
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License Number State | MD
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