Provider Demographics
NPI:1215740154
Name:SUSQUEHANNA OB-GYN LLC
Entity type:Organization
Organization Name:SUSQUEHANNA OB-GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-398-0189
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4375
Mailing Address - Country:US
Mailing Address - Phone:410-939-3121
Mailing Address - Fax:443-643-4303
Practice Address - Street 1:308 N UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2825
Practice Address - Country:US
Practice Address - Phone:410-939-3121
Practice Address - Fax:443-643-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty