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General NPI Number Information
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NPI Number | 1104818871
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA OB-GYN LLC
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 520 UPPER CHESAPEAKE DR SUITE 301
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City | BEL AIR
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State | MD
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Zip | 21014-4339
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Country | US
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Telephone | 410-939-3121
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Fax | 443-643-4303
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Provider Business Mailing Address
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Address Line | 520 UPPER CHESAPEAKE DR SUITE 301
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City | BEL AIR
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State | MD
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Zip | 21014-4339
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Country | US
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Telephone | 443-643-4300
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Fax | 443-643-4303
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | VICTORIA DODSON
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Credential |
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Telephone | 443-398-0189
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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 | D0033079
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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