Provider Demographics
NPI:1326150772
Name:FORLIFER, SUSAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:T
Last Name:FORLIFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:920 ELKRIDGE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2917
Mailing Address - Country:US
Mailing Address - Phone:410-684-2031
Mailing Address - Fax:
Practice Address - Street 1:522 CYNWOOD DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3805
Practice Address - Country:US
Practice Address - Phone:410-822-5600
Practice Address - Fax:410-770-5261
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036919208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD210961100Medicaid
MDD93457Medicare UPIN
MD210961100Medicaid