Basic Information
| Provider Information | |||||||||
| NPI: | 1548753387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROSSER | ||||||||
| FirstName: | SUSAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 DALE DR | ||||||||
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| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214034309 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 MEDICAL PKWY STE 404 | ||||||||
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| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A4155 | MD | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.