Provider Demographics
NPI:1962812339
Name:SUSAN GERSHOWITZ PA
Entity type:Organization
Organization Name:SUSAN GERSHOWITZ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT.
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MAC
Authorized Official - Phone:410-484-3709
Mailing Address - Street 1:3655 A OLD COURT RD. SUITE 10.
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
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 1:3655A OLD COURT RD SUITE 10
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSAN GERSHOWITZ PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU000269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty