Basic Information
| Provider Information | |||||||||
| NPI: | 1255372074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLBERGER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 PICCARD DR | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019217900 | ||||||||
| FaxNumber: | 3019217915 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 TOWN CENTER PARKWAY | ||||||||
| Address2: | RESTON HOSPITAL CENTER | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036899037 | ||||||||
| FaxNumber: | 7036899109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110840530 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.