Provider Demographics
NPI:1447253679
Name:WOODLAN, SUSANNE T (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:T
Last Name:WOODLAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7 GRANITE PL UNIT 416
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6594
Mailing Address - Country:US
Mailing Address - Phone:301-602-7166
Mailing Address - Fax:
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:STE 111
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1503
Practice Address - Country:US
Practice Address - Phone:301-774-6500
Practice Address - Fax:301-774-5461
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2020-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0050262207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376596200Medicaid
G59601Medicare UPIN