Active NPI
Susan Elizabeth Wandishin, M.D.
- Pediatrics Physician
- Owings Mills, MD
National Provider Identifier
1588770366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0040033
- Practice address
- 10085 Red Run Blvd
Sutie 103
Owings Mills, MD 21117-4836 - Phone
- (410) 363-2240
- Fax
- (410) 363-3858
- NPI assigned
- Aug 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0040033 | MD | Primary |
Addresses
Primary practice location
10085 Red Run Blvd
Sutie 103
Owings Mills, MD 21117-4836
Mailing address
10085 Red Run Blvd
Sutie 103
Owings Mills, MD 21117-4836
Phone (410) 363-2240
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0040033 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588770366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10085 RED RUN BLVD",
"address_2": "SUTIE 103",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "211174836",
"telephone_number": "410-363-2240",
"fax_number": "410-363-3858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10085 RED RUN BLVD",
"address_2": "SUTIE 103",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "211174836",
"telephone_number": "410-363-2240",
"fax_number": "410-363-3858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANDISHIN",
"first_name": "SUSAN",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0040033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owings Mills, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.