Individual provider Active NPI

Susan C. Cullom, D.O.

  • Family Medicine Physician
  • Bethesda, MD
National Provider Identifier
1619947165
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS 4857 Issued in FL
Practice address
National Naval Medical Center, Executive Health CL
8901 Wisconsin Avenue
Bethesda, MD 20889-0001
Phone
(301) 319-8283
NPI assigned
Jan 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS 4857 FL Primary

Addresses

Primary practice location

National Naval Medical Center, Executive Health CL
8901 Wisconsin Avenue
Bethesda, MD 20889-0001

Mailing address

12646 Timonium Ter
North Potomac, MD 20878-3139
Phone (301) 990-0358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130517000220 MD Order and Referring Only - Family PracticePractitioner - Family Practice 6507003209

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS 4857FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Windber 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.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1619947165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12646 TIMONIUM TER",
            "city": "NORTH POTOMAC",
            "state": "MD",
            "postal_code": "208783139",
            "telephone_number": "301-990-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NATIONAL NAVAL MEDICAL CENTER, EXECUTIVE HEALTH CL",
            "address_2": "8901 WISCONSIN AVENUE",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208890001",
            "telephone_number": "301-319-8283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLOM",
        "first_name": "SUSAN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2026-07-13",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS 4857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

Verify at the official NPI Registry.