MEDICARE: MR. MICHAEL F BURGER LCPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor	LC11805	MD

General Provider Information

NPI Number	:	1497313456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL F BURGER LCPC

Provider Business Mailing Address
First Line	:	6951 BENTON CT
Second Line	:
City	:	KING GEORGE
State	:	VA
Zip	:	22485-5469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 SAINT PATRICKS DR
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-5529
Country	:	US
Telephone Number	:	240-257-2151
Fax Number	:

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

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	09/07/2022

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