Provider Demographics
NPI:1780916767
Name:HORMOZI, SUSAN EAPEN (LAC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EAPEN
Last Name:HORMOZI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:8415 BELLONA LN
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2055
Mailing Address - Country:US
Mailing Address - Phone:410-825-8222
Mailing Address - Fax:410-825-6439
Practice Address - Street 1:8415 BELLONA LN
Practice Address - Street 2:SUITE 212
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2055
Practice Address - Country:US
Practice Address - Phone:410-825-8222
Practice Address - Fax:410-825-6439
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDU01140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist