Provider Demographics
NPI:1205879111
Name:BERGER, SUSAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LUBRANO DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7028
Mailing Address - Country:US
Mailing Address - Phone:410-897-1941
Mailing Address - Fax:410-630-8067
Practice Address - Street 1:128 LUBRANO DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7028
Practice Address - Country:US
Practice Address - Phone:410-897-1941
Practice Address - Fax:410-630-8067
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0075254207RR0500X
MI4301084883207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000007319OtherPHP OF MICHIGAN
MI110C314380OtherBLUE CROSS GROUP PIN
MI4857444Medicaid
MI1017843OtherMCLAREN
MI1017843OtherMCLAREN
MIP41320003Medicare PIN