Provider Demographics
NPI:1841415072
Name:DUGGAN, SUSAN KAREN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAREN
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:KAREN
Other - Last Name:BAVARD ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7750 MONTPELIER RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6010
Mailing Address - Country:US
Mailing Address - Phone:410-888-9048
Mailing Address - Fax:410-888-9004
Practice Address - Street 1:7750 MONTPELIER RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6010
Practice Address - Country:US
Practice Address - Phone:410-888-9048
Practice Address - Fax:410-888-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD769501-03OtherCAREFIRST NON-PAR NO.