MEDICARE: DR. SUSANNE T WOODLAN 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	207VB0002X	Obesity Medicine (Obstetrics & Gynecology) Physician	D0050262	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447253679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNE T WOODLAN M.D.

Provider Business Mailing Address
First Line	:	7 GRANITE PL UNIT 416
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-6594
Country	:	US
Telephone Number	:	301-602-7166
Fax Number	:

Provider Business Practice Location Address
First Line	:	18111 PRINCE PHILIP DR
Second Line	:	STE 111
City	:	OLNEY
State	:	MD
Zip	:	20832-1503
Country	:	US
Telephone Number	:	301-774-6500
Fax Number	:	301-774-5461

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/15/2020

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