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NPI Code Detail

MEDICARE: DR. DAVID THOMAS BURGGRAFF PHD

MEDICARE: DR. DAVID THOMAS BURGGRAFF PHD
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
1103TC0700XClinical Psychologist048-0000671VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
238071OTHERVTBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1760581748
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID THOMAS BURGGRAFF PHD
Provider Business Mailing Address
First Line : 16 RIDGE RD
Second Line :
City : CHARLOTTE
State : ME
Zip : 04666
Country : US
Telephone Number : 207-454-2771
Fax Number : 207-454-2771
Provider Business Practice Location Address
First Line : 11 BACK RD
Second Line :
City : PLEASANT POINT
State : ME
Zip : 04667-4119
Country : US
Telephone Number : 207-853-0644
Fax Number : 207-853-1630
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 10/18/2012

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