Provider Demographics
NPI:1689656050
Name:OWENS, SUSAN W (DR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:OWENS
Suffix:
Gender:F
Credentials:DR
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Other - Last Name:
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Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:FLOOR 2B BURNS BLDG
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2911
Mailing Address - Fax:202-741-2921
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:BETHESDA NAVAL MEDICAL CENTER
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD22751207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C88438Medicare UPIN