Provider Demographics
NPI:1932322492
Name:HAFIZ, SUSANNE MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:MICHELLE
Last Name:HAFIZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BRYANS MILL WAY
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5454
Mailing Address - Country:US
Mailing Address - Phone:410-440-6993
Mailing Address - Fax:410-418-8778
Practice Address - Street 1:8388 COURT AVE STE 101
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4514
Practice Address - Country:US
Practice Address - Phone:410-418-8840
Practice Address - Fax:410-418-8778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist