MEDICARE: DR. SUSAN KOSNIK ROSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0017036	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27341	OTHER	DE	COVENTRY
2	T0040001	OTHER	DC	CARE FIRST
3	7195SK	OTHER	MD	CARE FIRST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	30837	OTHER		JOHNS HOPKINS
6	2101167	OTHER		MAMSI

General Provider Information

NPI Number	:	1417950080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN KOSNIK ROSS M.D.

Provider Business Mailing Address
First Line	:	900 ELKRIDGE LANDING RD FL 2
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2924
Country	:	US
Telephone Number	:	443-462-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BROWN ST STE 320
Second Line	:
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620
Country	:	US
Telephone Number	:	410-778-1878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/03/2024

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