Provider Demographics
NPI:1376749333
Name:WATERMAN, SUSAN ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANDREA
Last Name:WATERMAN
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-0208
Mailing Address - Country:US
Mailing Address - Phone:240-760-9285
Mailing Address - Fax:
Practice Address - Street 1:9972 FOXBOROUGH CIR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4613
Practice Address - Country:US
Practice Address - Phone:703-766-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS284002084N0400X
TN625052084N0400X
MI43015032142084P0800X
VA0498322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology