Physician Compare National (NPI:1902867781)

HEALTHCARE PROVIDER: SUSAN J HENLEY MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902867781
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6507040888
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110411000787
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENLEY
	Individual professional last name
Provider First Name	SUSAN
	Individual professional first name
Provider Middle Name	JEAN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1501 SULGRAVE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 306
	Group Practice or individual's line 2 address
City	BALTIMORE
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	212093651
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4104338801
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	210012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SINAI HOSPITAL OF BALTIMORE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	210040
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHWEST HOSPITAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y