Provider Demographics
NPI:1881897510
Name:WOLLERSHEIM, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WOLLERSHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:GEORGETOWN UNIVERSITY HOSPITAL, PEDS ID, 2-PHC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-8262
Mailing Address - Fax:202-444-7161
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:GEORGETOWN UNIVERSITY HOSPITAL, PEDS ID, 2-PHC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8262
Practice Address - Fax:202-444-7161
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics