Basic Information
| Provider Information | |||||||||
| NPI: | 1801954714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERSOFF-MATCHA | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 EAST JEFFERSON STREET | ||||||||
| Address2: | PPQA MEDICARE COMPLIANCE UNIT 6 WEST | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018166660 | ||||||||
| FaxNumber: | 3018166308 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 W PENNSYLVANIA AVE | ||||||||
| Address2: | WEST END MEDICAL CENTER | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200374236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028727232 | ||||||||
| FaxNumber: | 2028727212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 10/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D54654 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 0101221439 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | MD31578 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.