=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114151842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INGRID MARGUERITE BURGER M.D., PH.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2009
-----------------------------------------------------
Last Update Date | 12/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UNIVERSITY OF CALIFORNIA SAN FRANCISCO 505 PARNASSUS, M-391
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94143-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-476-8358
-----------------------------------------------------
Fax | 415-476-0616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UNIVERSITY OF CALIFORNIA SAN FRANCISCO 505 PARNASSUS, M-391
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94143-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-476-8358
-----------------------------------------------------
Fax | 415-476-0616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | A107043
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------