Michael John Superior, MD, MPH

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

C1-0008620 Issued in DE

Practice address

5158 Black Hawk Rd
Aberdeen Proving Ground, MD 21010-5403

Phone

(410) 436-5127

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503014400000",
    "number": "1629164447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5158 BLACK HAWK RD",
            "city": "ABERDEEN PROVING GROUND",
            "state": "MD",
            "postal_code": "210105403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5158 BLACK HAWK RD",
            "city": "ABERDEEN PROVING GROUND",
            "state": "MD",
            "postal_code": "210105403",
            "telephone_number": "410-436-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERIOR",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2017-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "GA",
            "license": "62171",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NJ",
            "license": "25MA09423100",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "DE",
            "license": "C1-0008620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Cherie Sedlak, RN
• Jenna Marie Sembrat, OD
• Barbara Wirtz Siskind, M.D.
• Matthew David Sommer, CRNP
• Valerie K. Sommer, MSA,BSN,RN,BC,COHN-S
• Thomas B Talbot, MD
• Carrie Ellen Theiss, LPN
• Jill Marie Thomas, CNA
• Kathleen Tierno, PHARM.D.
• Deborah Trabue, PTA

• Public Health & General Preventive Medicine Physician in Aberdeen Proving Ground, MD
• Providers in Aberdeen Proving Ground, MD by specialty
• Public Health & General Preventive Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.