Healthcare Provider Details

I. General information

NPI: 1891861563
Provider Name (Legal Business Name): JENNIFER L BURGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 EAST STREET
CONCORD CA
94520
US

IV. Provider business mailing address

2165 EAST STREET
CONCORD CA
94520
US

V. Phone/Fax

Practice location:
  • Phone: 925-827-9195
  • Fax: 925-827-9278
Mailing address:
  • Phone: 925-827-9195
  • Fax: 925-827-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: