1669552683 NPI number — SUSAN BIENER BERGMAN M.D.

Table of content: SUSAN BIENER BERGMAN M.D. (NPI 1669552683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669552683 NPI number — SUSAN BIENER BERGMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGMAN
Provider First Name:
SUSAN
Provider Middle Name:
BIENER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669552683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUTTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01590-0226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-865-0890
Provider Business Mailing Address Fax Number:
508-865-5226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WORCESTER RD
Provider Second Line Business Practice Location Address:
SUITE LL3
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-5356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-405-4566
Provider Business Practice Location Address Fax Number:
508-405-4511
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  54458 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2329074 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 376573 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 80207 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 200068365 . This is a "HEALTHCARE VALUE MANAGEME" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6195237 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2309066 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005108 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 708500 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J04587 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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