Provider Demographics
NPI:1801954714
Name:BERSOFF-MATCHA, SUSAN J (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:BERSOFF-MATCHA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:2100 W PENNSYLVANIA AVE
Practice Address - Street 2:WEST END MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-4236
Practice Address - Country:US
Practice Address - Phone:202-872-7232
Practice Address - Fax:202-872-7212
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-10-14
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Provider Licenses
StateLicense IDTaxonomies
MDD54654207R00000X
VA0101221439207RI0200X
DCMD31578207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
008694M92Medicare ID - Type Unspecified
G24232Medicare UPIN