Provider Demographics
NPI:1871730739
Name:JOHNSON FUTRELL, SUZETTE MARTINA (DO)
Entity type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:MARTINA
Last Name:JOHNSON FUTRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 759047
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9047
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:402 BEETLEBROOK DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2583
Practice Address - Country:US
Practice Address - Phone:443-866-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0071825207Q00000X
MDH71825208M00000X
PAOT012557207Q00000X
MDH78125208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD534865YWV2Medicare PIN
MD216951YVZMedicare PIN
MD216951ZDDBMedicare PIN
MD216951YVZMedicare PIN