Healthcare Provider Details

I. General information

NPI: 1881897510
Provider Name (Legal Business Name): SUSAN WOLLERSHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW GEORGETOWN UNIVERSITY HOSPITAL, PEDS ID, 2-PHC
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW GEORGETOWN UNIVERSITY HOSPITAL, PEDS ID, 2-PHC
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8262
  • Fax: 202-444-7161
Mailing address:
  • Phone: 202-444-8262
  • Fax: 202-444-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA98028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: