| Medspa M.D. LLC | |
|
1804 W North Ave Baltimore MD 21217-1621 | |
| (410) 685-6331 | |
| (410) 685-6332 |
| Full Name | Medspa M.D. LLC |
|---|---|
| Speciality | General Practice |
| Location | 1804 W North Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Susan Renee Clanzy (CEO) |
| Authorized Official Contact | 4104462257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medspa M.D. LLC 1804 W North Ave Baltimore MD 21217-1621 Ph: (410) 685-6331 | Medspa M.D. LLC 1804 W North Ave Baltimore MD 21217-1621 Ph: (410) 685-6331 |
| NPI Number | 1871848614 |
|---|---|
| Provider Enumeration Date | 07/18/2012 |
| Last Update Date | 12/10/2025 |
| Certification Date | 12/10/2025 |
| Medicare PECOS PAC ID | 4082862461 |
|---|---|
| Medicare Enrollment ID | O20120910000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871848614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | D0060902 (Maryland) | Primary |
| Provider Name | Susan R Clanzy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1568435634 PECOS PAC ID: 4587751573 Enrollment ID: I20071108000104 |
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