Provider Demographics
NPI:1982083606
Name:SUSSMAN, MARK (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 WINTERS CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7704
Mailing Address - Country:US
Mailing Address - Phone:410-266-9120
Mailing Address - Fax:443-949-0226
Practice Address - Street 1:2926 WINTERS CHASE WAY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7704
Practice Address - Country:US
Practice Address - Phone:410-266-9120
Practice Address - Fax:443-949-0226
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00266213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine