Susquehanna OB-GYN LLC
Organization Active NPI Obstetrics & Gynecology Physician · Bel Air, MD
NPI 1104818871 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1104818871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- SUSQUEHANNA OB-GYN LLC
- Practice address
- 520 Upper Chesapeake Dr
Suite 301
Bel Air, MD 21014-4339 - Phone
- (410) 939-3121
- Fax
- (443) 643-4303
- NPI assigned
- Aug 18, 2005
- Organization subpart
- No
Authorized official
- Name
- Victoria Dodson
- Title
- Credentialing Manager
- Phone
- (443) 398-0189
Practitioners 43
-
Kathleen M Gotzmann, M.D.
-
Tiffany D Lopez, MSN, CRNP, WHNP-BC
-
Veronica Dawn Woodford, WHNP
-
Lori Ann Antinozzi, CNM
-
Dawn Heinbaugh, CNM
-
Laura Hogan, CNM
-
Kari Lindner, LCSW-C
-
Rebecca Striebinger, CNM
-
Debbie L Boyd, CRNP
-
Lindsey Noel Collins, CRNP
-
Christine Denise Diblasi, CRNP
-
Kristina Ann Doss, CNM
-
Mitra Foroogh-Nassiraee, M.D.
-
Melanie Ridgway Furrer, CNM, MSPHN, RN
-
Lucy Belyn Gant, CNM
-
Pouya Javadian, M.D.
-
Chanan Levy, MD
-
Nelly Molano, C.R.N.P.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040724000337 | MD | Part B Supplier - Clinic/Group Practice | 9335129766 |
Receives reassigned benefits from 13 practitioners Practice locations: Bel Air, MD; Havre de Grace, MD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | D0033079 | MD | |
| Obstetrics & Gynecology Physician |
207V00000X | Yes |
Addresses
Primary practice location
520 Upper Chesapeake Dr
Suite 301
Bel Air, MD 21014-4339
Mailing address
520 Upper Chesapeake Dr
Suite 301
Bel Air, MD 21014-4339
Phone (443) 643-4300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| KQ13 | Other | MD | MEDICARE GROUP ID |
| 499251202 | Medicaid | MD | |
| 232921200 | Medicaid | MD |
Other providers in Bel Air, MD
- Erik Sundquist
- Sunnylife LLC
- Surgcenter of Bel Air
- Judith Surowiec
- Susquehanna Medical Associates, LLP.
- Susquehanna OB-GYN LLC
- Jill Allen Svrjcek
- Matthew Thomas Swan
- James Raymond Swanbeck Jr.
- Justin Michael Swanson
All providers in Bel Air, MD · Obstetrics & Gynecology Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.