Provider Demographics
NPI:1427134337
Name:GERSHOWITZ, SUSAN CAROL (RPT MAC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:GERSHOWITZ
Suffix:
Gender:F
Credentials:RPT MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3655 A OLD COURT ROAD
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-484-3709
Mailing Address - Fax:410-484-0580
Practice Address - Street 1:3655 A OLD COURT ROAD
Practice Address - Street 2:SUITE # 10
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-484-3709
Practice Address - Fax:410-484-0580
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15577225100000X
MDU00269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J246SCMedicare ID - Type Unspecified