Provider Demographics
NPI:1073525465
Name:LAESSIG, SUSAN L (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:LAESSIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70608
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20813-0608
Mailing Address - Country:US
Mailing Address - Phone:202-829-0022
Mailing Address - Fax:202-829-2927
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:STE 205
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-829-0170
Practice Address - Fax:202-829-2927
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14114207RG0100X
MDD0030127207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC117671M02Medicare PIN
B93482Medicare UPIN