Provider Demographics
NPI:1417950080
Name:ROSS, SUSAN KOSNIK (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KOSNIK
Last Name:ROSS
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 1:126 PHILOSOPHERS TER STE 102
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1612
Mailing Address - Country:US
Mailing Address - Phone:410-778-1878
Mailing Address - Fax:410-778-1766
Practice Address - Street 1:126 PHILOSOPHERS TER STE 102
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620
Practice Address - Country:US
Practice Address - Phone:410-778-1878
Practice Address - Fax:410-778-1766
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD252111300Medicaid
DE27341OtherCOVENTRY
30837OtherJOHNS HOPKINS
2101167OtherMAMSI
MD7195SKOtherCARE FIRST
DCT0040001OtherCARE FIRST
2101167OtherMAMSI
MD7195SKOtherCARE FIRST