Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | D0062260 | MD |
N | 207NP0225X | Pediatric Dermatologist | D0062260 | MD |
N | 207NS0135X | Procedural Dermatology | D0062260 | MD |
NPI | 1154377448 |
---|---|
Provider Name | Susan Mclaughlin |
First Address | Elkridge, MD 21075-6433 |
Second Address | Elkridge, MD 21075-6433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
409618500 | (05) | MD |
I48701 | (02) | |
KT93 / 648783-011 | BC / BS OF MD (01) | MD |
S186 / S 186 | BLUECHOICE (01) | MD |