MEDICARE: DR. SUSAN E JENKINS 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	207VG0400X	Gynecology Physician	D0038258	MD

General Provider Information

NPI Number	:	1942299417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN E JENKINS M.D

Provider Business Mailing Address
First Line	:	1450 MERCANTILE LN
Second Line	:	SUITE 117
City	:	LARGO
State	:	MD
Zip	:	20774-5376
Country	:	US
Telephone Number	:	301-583-0500
Fax Number	:	301-390-1984

Provider Business Practice Location Address
First Line	:	1450 MERCANTILE LN
Second Line	:	SUITE 117
City	:	LARGO
State	:	MD
Zip	:	20774-5376
Country	:	US
Telephone Number	:	301-583-0500
Fax Number	:	301-390-1984

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/19/2022

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