Provider Demographics
NPI:1376749333
Name:WATERMAN, SUSAN ANDREA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANDREA
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 CAMPUS COMMONS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1535
Mailing Address - Country:US
Mailing Address - Phone:866-212-7537
Mailing Address - Fax:833-219-0399
Practice Address - Street 1:9972 FOXBOROUGH CIR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4613
Practice Address - Country:US
Practice Address - Phone:703-766-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS284002084N0400X
TN625052084N0400X
MI43015032142084P0800X
SC879292084P0800X
VA0498322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology