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General NPI Number Information
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NPI Number | 1619947165
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Entity Type | Individual
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Provider Name | SUSAN C. CULLOM D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | NATIONAL NAVAL MEDICAL CENTER, EXECUTIVE HEALTH CL 8901 WISCONSIN AVENUE
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-319-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 12646 TIMONIUM TER
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City | NORTH POTOMAC
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State | MD
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Zip | 20878-3139
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Country | US
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Telephone | 301-990-0358
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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 | OS 4857
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License Number State | FL
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