Organization
SUSQUEHANNA OB-GYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA DODSON (CREDENTIALING MANAGER)
(443) 398-0189
Entity
Organization
Contact information
Practice address
520 UPPER CHESAPEAKE DR, SUITE 301, BEL AIR, MD 21014-4339
(410) 939-3121
(443) 643-4303
Mailing address
520 UPPER CHESAPEAKE DR, SUITE 301, BEL AIR, MD 21014-4339
(443) 643-4300
(443) 643-4303
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D0033079
MD
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232921200
—
MD
05
—
499251202
—
MD
01
—
KQ13
MEDICARE GROUP ID
MD
Enumeration date
08/18/2005
Last updated
01/27/2025
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