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General NPI Number Information
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NPI Number | 1669552683
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Entity Type | Individual
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Provider Name | SUSAN BIENER BERGMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 600 WORCESTER RD SUITE LL3
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City | FRAMINGHAM
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State | MA
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Zip | 01702-5356
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Country | US
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Telephone | 508-405-4566
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Fax | 508-405-4511
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Provider Business Mailing Address
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Address Line | PO BOX 226
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City | SUTTON
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State | MA
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Zip | 01590-0226
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Country | US
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Telephone | 508-865-0890
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Fax | 508-865-5226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 54458
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License Number State | MA
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