Provider Demographics
NPI:1942299417
Name:JENKINS, SUSAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1450 MERCANTILE LN
Mailing Address - Street 2:SUITE 117
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5376
Mailing Address - Country:US
Mailing Address - Phone:301-583-0500
Mailing Address - Fax:301-390-1984
Practice Address - Street 1:1450 MERCANTILE LN
Practice Address - Street 2:SUITE 117
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5376
Practice Address - Country:US
Practice Address - Phone:301-583-0500
Practice Address - Fax:301-390-1984
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0038258207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD700269Medicare ID - Type Unspecified
MDF07985Medicare UPIN