MEDICARE: DR. SUSAN RENEE CLANZY 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	208D00000X	General Practice Physician	D0060902	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	:	1568435634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN RENEE CLANZY M.D.

Provider Business Mailing Address
First Line	:	1804 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-1621
Country	:	US
Telephone Number	:	410-685-6331
Fax Number	:	410-685-6332

Provider Business Practice Location Address
First Line	:	1804 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-1621
Country	:	US
Telephone Number	:	410-685-6331
Fax Number	:	410-685-6332

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	12/10/2025

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Directions to “ DR. SUSAN RENEE CLANZY M.D.” Practice Location

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