Provider Demographics
NPI:1639722036
Name:GORSCHBOTH, SUSAN P (DNP AGPCNP-BC/C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:GORSCHBOTH
Suffix:
Gender:F
Credentials:DNP AGPCNP-BC/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 BOX HILL CORPORATE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1251
Mailing Address - Country:US
Mailing Address - Phone:410-671-0017
Mailing Address - Fax:
Practice Address - Street 1:3401 BOX HILL CORPORATE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1251
Practice Address - Country:US
Practice Address - Phone:410-671-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122278163W00000X, 363LP2300X
DELP-0000319363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health