Provider Demographics
NPI:1497887764
Name:PUSH, SUSAN LEE (ACUPUNCTURE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEE
Last Name:PUSH
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BURBAGE CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2541
Mailing Address - Country:US
Mailing Address - Phone:410-931-9238
Mailing Address - Fax:
Practice Address - Street 1:30 BURBAGE CT
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2541
Practice Address - Country:US
Practice Address - Phone:410-931-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00942171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist