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General NPI Number Information
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NPI Number | 1366427940
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Entity Type | Individual
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Provider Name | SUSAN MADONNA D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 8871 GORMAN RD SUITE 300
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City | LAUREL
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State | MD
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Zip | 20723-5877
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Country | US
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Telephone | 301-498-3150
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Fax | 301-490-2411
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Provider Business Mailing Address
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Address Line | 9649 BELAIR RD SECOND FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21236-1100
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Country | US
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Telephone | 410-248-2650
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Fax | 410-248-2656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H59597
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License Number State | MD
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