Provider Demographics
NPI:1750365011
Name:ALLIG, SUSAN M (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ALLIG
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 CHADBURN PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-4031
Mailing Address - Country:US
Mailing Address - Phone:240-620-3303
Mailing Address - Fax:
Practice Address - Street 1:20680 SENECA MEADOWS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7029
Practice Address - Country:US
Practice Address - Phone:301-701-6900
Practice Address - Fax:703-742-9081
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR065088367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS417 0019OtherCAREFIRST BCBS
MD190631300Medicaid
MDKBC1CHOtherCAREFIRST BCBS
MD161196Y2MMedicare PIN
MD190631300Medicaid