Provider Demographics
NPI:1720195159
Name:FORMAN, SUZANNE D (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:D
Last Name:FORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-881-3700
Mailing Address - Fax:301-309-2596
Practice Address - Street 1:6123 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4860
Practice Address - Country:US
Practice Address - Phone:301-881-3700
Practice Address - Fax:301-309-2596
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00524272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD450712600Medicaid
MD450712600Medicaid