Healthcare Provider Details

I. General information

NPI: 1467569541
Provider Name (Legal Business Name): TODD ERIC BURDETTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST STE 201
CONCORD NH
03301-2588
US

IV. Provider business mailing address

246 PLEASANT ST STE 210
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-5200
  • Fax: 603-224-5091
Mailing address:
  • Phone: 603-224-5200
  • Fax: 603-224-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number14751
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: