MEDICARE: DR. ALICIA WASSERMAN SUSSMAN 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	207V00000X	Obstetrics & Gynecology Physician	D70666	MD

General Provider Information

NPI Number	:	1427273739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA WASSERMAN SUSSMAN M.D.

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	8028 RITCHIE HWY STE 134
Second Line	:	KAISER PERMANENTE SEVERNA PARK MEDICAL CENTER
City	:	PASADENA
State	:	MD
Zip	:	21122-1030
Country	:	US
Telephone Number	:	410-553-2400
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	06/06/2021

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