MEDICARE: SUZANNE L WERTHEIMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	223520	MA

General Provider Information

NPI Number	:	1174631881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE L WERTHEIMER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 723
Second Line	:
City	:	HYANNIS PORT
State	:	MA
Zip	:	02647-0723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA HYANNIS PRIMARY CARE
Second Line	:	145 FALMOUTH RD
City	:	HYANNIS
State	:	MA
Zip	:	02610
Country	:	US
Telephone Number	:	508-771-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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