Provider Demographics
NPI:1194083899
Name:EBRAHIMI, SUZAN (MD)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7247 HANOVER PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3661
Mailing Address - Country:US
Mailing Address - Phone:301-345-5513
Mailing Address - Fax:301-345-5608
Practice Address - Street 1:7247 HANOVER PKWY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3661
Practice Address - Country:US
Practice Address - Phone:301-345-5513
Practice Address - Fax:301-345-5608
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD040822207RG0100X
MDD0080759207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology