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1811980030

NPI Code Detail

MEDICARE: THEODORE BURDEN MD

MEDICARE: THEODORE BURDEN MD

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	207R00000X	Internal Medicine Physician	MD020774E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00037862	OTHER	PA	RAILROAD MEDICARE
6	597586	OTHER	PA	MEDICARE GROUP
7	CD4829	OTHER	PA	RAILROAD MEDICARE TPI GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1019558	OTHER	PA	KEYSTONE MERCY HEALTH
4	0054331000	OTHER	PA	INDEPENDENCE BLUE CROSS
5	128306	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1811980030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE BURDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-926-9022
Fax Number	:	215-226-8286

Provider Business Practice Location Address
First Line	:	2100 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1400
Country	:	US
Telephone Number	:	215-685-0800
Fax Number	:	215-685-0846

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/18/2011

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Directions to “ THEODORE BURDEN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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