Provider Demographics
NPI:1164533584
Name:STEIN, SUSAN DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEBORAH
Last Name:STEIN
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 1:2150 PENNSYLVANIA AVE NW FL 9
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-463-8548
Mailing Address - Fax:202-463-0476
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW FL 9
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-463-8548
Practice Address - Fax:202-463-0476
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM30567208C00000X
DCMD11008208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0021982OtherLICENSE
DCMD11008OtherLICENSE