Provider Demographics
NPI:1104143122
Name:TUDDENHAM, SUSAN A (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:TUDDENHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5200 EASTERN AVE BLDG CENTER
Mailing Address - Street 2:DIVISION OF INFECTIOUS DISEASES, SUITE 381
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2734
Mailing Address - Country:US
Mailing Address - Phone:410-550-7330
Mailing Address - Fax:410-550-1169
Practice Address - Street 1:5200 EASTERN AVE BLDG CENTER
Practice Address - Street 2:DIVISION OF INFECTIOUS DISEASES, SUITE 381
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2734
Practice Address - Country:US
Practice Address - Phone:410-550-7330
Practice Address - Fax:410-550-1169
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0080348207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program