Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD006480E | PA |
NPI | 1316257884 |
---|---|
Provider Name | Dr. Theodore P. Burger |
First Address | Bethlehem, PA 18017-1736 |
Second Address | Bethlehem, PA 18017-1736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 18/10/2010 |