Healthcare Provider Details

I. General information

NPI: 1811980030
Provider Name (Legal Business Name): THEODORE BURDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W GIRARD AVE
PHILADELPHIA PA
19130-1400
US

IV. Provider business mailing address

PO BOX 820933
PHILADELPHIA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-0800
  • Fax: 215-685-0846
Mailing address:
  • Phone: 215-926-9022
  • Fax: 215-226-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD020774E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: