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SUSQUEHANNA OB-GYN LLC
NPI 1104818871
Obstetrics & Gynecology in Bel Air, MD

Active since August 18, 2005CLIA 21D0678270 · Microscopy
520 UPPER CHESAPEAKE DR, SUITE 301, BEL AIR, MD 21014(410) 939-3121(443) 643-4303 Get Directions Write a Review

NPPES record last updated: January 27, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Susquehanna Ob-gyn Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSQUEHANNA OB-GYN LLC (NPI 1104818871) is a healthcare organization registered as an obstetrics & gynecology in Bel Air, Maryland and active in the NPI registry since August 2005. The organization holds a CLIA Microscopy certificate valid through August 31, 2028 and lists Victoria Dodson, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1104818871
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NameSUSQUEHANNA OB-GYN LLC
Location Address520 UPPER CHESAPEAKE DR, SUITE 301Bel Air, MD 21014-4339
Mailing Address520 Upper Chesapeake Dr, Suite 301Bel Air, MD 21014-4339 · (443) 643-4300 · Fax (443) 643-4303
Phone(410) 939-3121
Fax(443) 643-4303
Organization SubpartNo
Authorized OfficialVictoria DodsonCredentialing Manager · (443) 398-0189
Enumeration DateAugust 18, 2005
Last NPPES UpdateJanuary 27, 2025
NPPES CertifiedJanuary 27, 2025
✔ NPI 1104818871 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
Also ListedSpecialistTaxonomy 174400000X · License D0033079 (MD)
520 UPPER CHESAPEAKE DR, Bel Air, MD 21014
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Other Identifiers 3

OtherKQ13MD · Medicare Group Id
Medicaid499251202MD
Medicaid232921200MD

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Susquehanna Ob-gyn Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateMarylandEnrollment IDO20040724000337Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

13

Medicare enrollment records show 13 clinicians reassign Medicare billing to Susquehanna Ob-Gyn LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 9 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 4

Certified Nurse Midwife (CNM)4
Nurse Practitioner4
Obstetrics/Gynecology4
Clinical Social Worker1

Clinicians, nearest first (13)

Veronica Woodford, WHNP
Nurse Practitioner
NPI 1720335441
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(410) 939-3121
✔ PECOS✔ Accepts MedicareSame address
Dawn Heinbaugh, CNM
Certified Nurse Midwife (CNM)
NPI 1679237572
520 UPPER CHESAPEAKE DR
Bel Air, MD 21014
(443) 643-4300
✔ PECOS✔ Accepts Medicare0.1 mi
Laura Hogan, CNM
Certified Nurse Midwife (CNM)
NPI 1164046421
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(443) 643-4300
✔ PECOS✔ Accepts Medicare0.1 mi
Carrie Kirkpatrick
Nurse Practitioner
NPI 1386210490
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(410) 939-3121
✔ PECOS✔ Accepts Medicare0.1 mi
Kari Lindner, LCSW-C
Clinical Social Worker
NPI 1851081087
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(443) 643-4300
✔ PECOS0.1 mi
Tiffany Lopez, MSN, CRNP, WHNP-BC
Nurse Practitioner
NPI 1033703640
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(443) 643-4300
✔ PECOS✔ Accepts Medicare0.1 mi
Rebecca Striebinger, CNM
Certified Nurse Midwife (CNM)
NPI 1326740226
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(410) 939-3121
✔ PECOS0.1 mi
Ibrahim Tsolakian, MD
Obstetrics/Gynecology
NPI 1194380428
520 UPPER CHESAPEAKE DR SUITE 301
Bel Air, MD 21014
(443) 643-4300
✔ PECOS✔ Accepts Medicare0.1 mi
Hillary Wilcox, FNP
Nurse Practitioner
NPI 1962116749
520 UPPER CHESAPEAKE DR STE 301
Bel Air, MD 21014
(410) 939-3121
✔ PECOS✔ Accepts Medicare0.1 mi
Lori Antinozzi, CNM
Certified Nurse Midwife (CNM)
NPI 1306120035
308 N UNION AVE
Havre De Grace, MD 21078
(410) 939-4159
✔ PECOS✔ Accepts Medicare14 mi
Kathleen Gotzmann, M.D.
Obstetrics/Gynecology
NPI 1740272228
308 N UNION AVE
Havre De Grace, MD 21078
(410) 939-3121
✔ PECOS✔ Accepts Medicare14 mi
Jonathan Sommerville, MD
Obstetrics/Gynecology
NPI 1841273521
308 N. UNION AVENUE
Havre De Grace, MD 21078
(410) 939-3121
✔ PECOS✔ Accepts Medicare14 mi
Elena Bryce
Obstetrics/Gynecology
NPI 1972980613
9715 MEDICAL CENTER DR STE 315
Rockville, MD 20850
(301) 681-6772
✔ PECOS✔ Accepts Medicare54 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 21D0678270

Susquehanna Obgyn LLC · Havre De Grace, MD
Active · expires Aug 31, 2028
CLIA Number21D0678270
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2026
Certificate Expiration DateAugust 31, 2028
Laboratory DirectorKathleen Gotzmann
Laboratory Phone(410) 939-3121
Laboratory LocationSusquehanna Obgyn LLC308 N Union Ave, Havre De Grace, MD 21078
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susquehanna Ob-Gyn LLC's NPI number?

The NPI number for Susquehanna Ob-Gyn LLC is 1104818871. It was assigned to this organization in the NPPES registry on August 18, 2005.

Where is Susquehanna Ob-Gyn LLC located?

Susquehanna Ob-Gyn LLC is located at 520 Upper Chesapeake Dr Suite 301, Bel Air, MD 21014. The listed phone number is (410) 939-3121.

What is Susquehanna Ob-Gyn LLC's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Susquehanna Ob-Gyn LLC enrolled in Medicare?

Yes. Susquehanna Ob-Gyn LLC is registered in the Medicare PECOS enrollment system.

When is Susquehanna Ob-Gyn LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Maryland, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Susquehanna Ob-Gyn LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 13 clinicians in 4 Medicare specialties reassign their Medicare billing to Susquehanna Ob-Gyn LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Certified Nurse Midwife (CNM) (4), Nurse Practitioner (4) and Obstetrics/Gynecology (4). Of these, 1 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Susquehanna Ob-Gyn LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 21D0678270) is associated with this NPI, valid through August 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Susquehanna Ob-Gyn LLC was last updated on January 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.