Provider Demographics
NPI:1588631824
Name:ABDO, SUZAN K (MD)
Entity Type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:K
Last Name:ABDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5005 SIGNAL BELL LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2606
Mailing Address - Country:US
Mailing Address - Phone:443-535-8500
Mailing Address - Fax:410-531-1446
Practice Address - Street 1:5005 SIGNAL BELL LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2606
Practice Address - Country:US
Practice Address - Phone:443-535-8500
Practice Address - Fax:410-531-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050878207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036300600Medicaid
MD110230864OtherRAILROAD MEDICARE
MDG38319Medicare UPIN
MD036300600Medicaid