Individual
PETER SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1438 DEFENSE HIGHWAY, SUITE 201, GAMBRILLS, MD 21054
(410) 721-3200
(410) 721-2680
Mailing address
1438 DEFENSE HIGHWAY, SUITE 201, GAMBRILLS, MD 21054
(410) 721-3200
(410) 721-2680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0056977
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13564
JOHNS HOPKINS HLTH CARE
—
01
—
165131
COVENTRY HEALTH
—
01
—
1S80P
BLUE CROSS BLUE SHIELD
—
01
—
223342
MAMSI
—
01
—
407044800
MEDICAL ASSISTANCE
—
05
—
407048800
—
MD
01
—
4301934
CIGNA
—
01
—
558223
INFORMED
—
01
—
7120279
AETNA
—
01
—
F1880001
BCBS FEDERAL
—
01
—
P15312
BCBS MPOS
—
Enumeration date
06/07/2006
Last updated
03/20/2019
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