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General NPI Number Information
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NPI Number | 1417950080
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Entity Type | Individual
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Provider Name | SUSAN KOSNIK ROSS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 100 BROWN ST STE 320
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City | CHESTERTOWN
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State | MD
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Zip | 21620
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Country | US
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Telephone | 410-778-1878
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Fax |
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Provider Business Mailing Address
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Address Line | 900 ELKRIDGE LANDING RD FL 2
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City | LINTHICUM
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State | MD
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Zip | 21090-2924
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Country | US
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Telephone | 443-462-5010
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Fax |
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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 | D0017036
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License Number State | MD
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