Provider Demographics
NPI:1942430848
Name:FERDMAN, SUZANNE (CRNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:FERDMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-1898
Mailing Address - Fax:410-328-7290
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-1898
Practice Address - Fax:410-328-7290
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR 178597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0370OtherCAREFIRST BC/BS REGIONAL
MD418863200Medicaid
MD956633-01 & 02OtherCAREFIRST BC/BS
MD168666Y3WMedicare PIN
MD956633-01 & 02OtherCAREFIRST BC/BS