Provider Demographics
NPI:1407180904
Name:BUSSE SIEGEL, SUSAN HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HELEN
Last Name:BUSSE SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:819 RITCHIE HWY
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4197
Mailing Address - Country:US
Mailing Address - Phone:410-544-2835
Mailing Address - Fax:410-647-0013
Practice Address - Street 1:819 RITCHIE HWY
Practice Address - Street 2:SUITE 2001
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4197
Practice Address - Country:US
Practice Address - Phone:410-544-2835
Practice Address - Fax:410-647-0013
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00323672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE15193Medicare UPIN