Provider Demographics
NPI:1669552683
Name:BERGMAN, SUSAN BIENER (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BIENER
Last Name:BERGMAN
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:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-0226
Mailing Address - Country:US
Mailing Address - Phone:508-865-0890
Mailing Address - Fax:508-865-5226
Practice Address - Street 1:600 WORCESTER RD
Practice Address - Street 2:SUITE LL3
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5356
Practice Address - Country:US
Practice Address - Phone:508-405-4566
Practice Address - Fax:508-405-4511
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2329074OtherAETNA
MA376573OtherCIGNA
MA80207OtherHARVARD PILGRIM HEALTH
MA200068365OtherHEALTHCARE VALUE MANAGEME
MA6195237Medicaid
2309066OtherUNITED HEALTHCARE
MA0005108OtherNEIGHBORHOOD HEALTH PLAN
MA708500OtherTUFTS HEALTH PLAN
MAJ04587OtherBLUE CROSS BLUE SHIELD
MAJ04587Medicare ID - Type UnspecifiedPROVIDER NUMBER
MA6195237Medicaid