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General NPI Number Information
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NPI Number | 1861483125
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Entity Type | Individual
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Provider Name | JUDITH BURGESS MD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 1 W ELM ST 2ND FLOOR
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2007
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Country | US
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Telephone | 610-567-6964
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Fax | 610-567-6170
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Provider Business Mailing Address
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Address Line | 1 W ELM ST STE 100
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-4108
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Country | US
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Telephone | 215-473-1515
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Fax | 215-473-1515
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD053751
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License Number State | PA
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