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General NPI Number Information
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NPI Number | 1982083606
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Entity Type | Individual
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Provider Name | MARK SUSSMAN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 2926 WINTERS CHASE WAY
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7704
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Country | US
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Telephone | 410-266-9120
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Fax | 443-949-0226
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Provider Business Mailing Address
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Address Line | 2926 WINTERS CHASE WAY
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7704
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Country | US
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Telephone | 410-266-9120
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Fax | 443-949-0226
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00266
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 00266
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License Number State | MD
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