Provider Demographics
NPI:1114952199
Name:SCHROCK, SUSAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:SCHROCK
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 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:
Practice Address - Street 1:14A MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120
Practice Address - Country:US
Practice Address - Phone:410-327-9283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62742207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409449200Medicaid
MDS1420020OtherCAREFIRST REGIONAL GBMC
MDKJ24/88438801OtherCAREFIRST MARYLAND GBMC
MD409449200Medicaid
MDS1420020OtherCAREFIRST REGIONAL GBMC
I42044Medicare UPIN