Healthcare Provider Details

I. General information

NPI: 1346576394
Provider Name (Legal Business Name): CHRISTINE ELIZABETH BURGERT-LON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 4200
NEWARK DE
19713-2075
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD STE 4200
NEWARK DE
19713-2075
US

V. Phone/Fax

Practice location:
  • Phone: 302-737-7700
  • Fax: 302-737-5407
Mailing address:
  • Phone: 302-737-7700
  • Fax: 302-737-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberC2-0023925
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberOS016227
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT013051
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC2-0023925
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: