Provider Demographics
NPI:1346271657
Name:ANTHONY, SUSAN B (CRNP, MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:CRNP, MS
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Mailing Address - Street 1:5525 RESEARCH PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:410-882-3240
Mailing Address - Fax:410-661-5093
Practice Address - Street 1:8800 WALTHER BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-9001
Practice Address - Country:US
Practice Address - Phone:410-882-3240
Practice Address - Fax:410-661-5093
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR079544363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS1380122OtherCAREFIRST REGIONAL GBMC
MDKJ15/60656602OtherCAREFIRST MARYLAND GBMC
S70693Medicare UPIN
MD725LO771Medicare PIN