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General NPI Number Information
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NPI Number | 1548256779
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Entity Type | Individual
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Provider Name | CAROL J BURGESS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DR
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City | BENNINGTON
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State | VT
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Zip | 05201-5004
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Country | US
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Telephone | 802-442-6361
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 WESTERN AVE SUITE B-1
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City | ALBANY
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State | NY
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Zip | 12203-3462
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Country | US
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Telephone | 518-458-2611
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Fax | 518-489-1914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 159113
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License Number State | NY
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