Provider Demographics
NPI:1073556429
Name:MELTZER, SUSAN S (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:MELTZER
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:12221-3 TULLAMORE ROAD
Practice Address - Street 2:MED. CARE CENTER AT MAYS CHAPEL
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-7816
Practice Address - Country:US
Practice Address - Phone:410-308-7808
Practice Address - Fax:410-308-7809
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-07-31
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Provider Licenses
StateLicense IDTaxonomies
MDD42410207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD194101100Medicaid
MDS589 047ZMedicare ID - Type Unspecified