Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | C20001890 | DE |
NPI | 1033225321 |
---|---|
Provider Name | Dr. Ralph Edward Burdick |
First Address | Delaware City, DE 19706-0300 |
Second Address | Delaware City, DE 19706-7706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 15/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000156703 | (05) | DE |
E05998 | (02) | DE |