Provider Demographics
NPI:1174508287
Name:MERSCH, SUSAN M (CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:MERSCH
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:10521 ROSEHAVEN ST STE LL100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2877
Practice Address - Country:US
Practice Address - Phone:703-281-5000
Practice Address - Fax:703-255-0765
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2023-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209004109367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174508287Medicaid
VA00024172631OtherLICENSE
IL340485837 / 01Medicaid
ILQ21361Medicare UPIN