MEDICARE: DR. TERRY D BURGER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	1420551	IN

General Provider Information

NPI Number	:	1164167813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY D BURGER PH.D.

Provider Business Mailing Address
First Line	:	28 ARBOR PL
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-7292
Country	:	US
Telephone Number	:	859-298-8955
Fax Number	:	812-725-8559

Provider Business Practice Location Address
First Line	:	110 E MARKET ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3410
Country	:	US
Telephone Number	:	812-946-6411
Fax Number	:	812-725-8559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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