Provider Demographics
NPI:1528032976
Name:BARUCH, SUSAN G I
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:BARUCH
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 FERNWOOD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:301-493-4440
Mailing Address - Fax:301-493-9778
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:STE 100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-493-4440
Practice Address - Fax:301-493-9778
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE60340Medicare UPIN
DC597618P45Medicare ID - Type Unspecified