MEDICARE: AMY SCALLY BURHANNA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MA072858	NJ
2	207RC0000X	Cardiovascular Disease Physician	25MA07285800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699725861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SCALLY BURHANNA M.D.

Provider Business Mailing Address
First Line	:	1 FEDERAL ST STE 200
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1088
Country	:	US
Telephone Number	:	848-288-6935
Fax Number	:	732-790-0107

Provider Business Practice Location Address
First Line	:	217 N MAIN ST
Second Line	:	SUITE 205
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-2165
Country	:	US
Telephone Number	:	609-463-5440
Fax Number	:	609-463-9888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/30/2024

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