Healthcare Provider Details

I. General information

NPI: 1831203504
Provider Name (Legal Business Name): MARY ELIZABETH BURDICK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SCIENCE PKWY
ROCHESTER NY
14620-4257
US

IV. Provider business mailing address

300 CRITTENDEN BLVD BOX PSYCH
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-300-5290
  • Fax:
Mailing address:
  • Phone: 585-276-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number230356
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number230356-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: