NPIMap

Organization Active NPI

Susquehanna OB-GYN LLC

  • Obstetrics & Gynecology Physician
  • Bel Air, MD
National Provider Identifier
1104818871
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 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
Last updated
Jan 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victoria Dodson
Title
Credentialing Manager
Phone
(443) 398-0189

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X D0033079 MD
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1104818871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 UPPER CHESAPEAKE DR",
            "address_2": "SUITE 301",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144339",
            "telephone_number": "443-643-4300",
            "fax_number": "443-643-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 UPPER CHESAPEAKE DR",
            "address_2": "SUITE 301",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144339",
            "telephone_number": "410-939-3121",
            "fax_number": "443-643-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA OB-GYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "DODSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "443-398-0189"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MD",
            "license": "D0033079",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.