Provider Demographics
NPI:1093943813
Name:SUSS, HEATHER ADINA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ADINA
Last Name:SUSS
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 1:6701 N CHARLES ST
Mailing Address - Street 2:# 4226
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6808
Mailing Address - Country:US
Mailing Address - Phone:201-745-4657
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST STE 4226
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-849-2202
Practice Address - Fax:410-337-5068
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09162900207L00000X
390200000X
MDD0083956207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD381007100Medicaid