Provider Demographics
NPI:1417950080
Name:ROSS, SUSAN KOSNIK (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KOSNIK
Last Name:ROSS
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 1:900 ELKRIDGE LANDING RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2924
Mailing Address - Country:US
Mailing Address - Phone:443-462-5010
Mailing Address - Fax:
Practice Address - Street 1:100 BROWN ST STE 320
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620
Practice Address - Country:US
Practice Address - Phone:410-778-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE27341OtherCOVENTRY
DCT0040001OtherCARE FIRST
MD7195SKOtherCARE FIRST
MD252111300Medicaid
30837OtherJOHNS HOPKINS
2101167OtherMAMSI
2101167OtherMAMSI
MD7195SKOtherCARE FIRST