Provider Demographics
NPI:1215946215
Name:BURGESS, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:4009 BLACK HORSE PIKE
Practice Address - Street 2:CHOP CARE NETWORK AT ATLANTIC COUNTY SC
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3133
Practice Address - Country:US
Practice Address - Phone:609-677-7895
Practice Address - Fax:609-677-7835
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06587600208000000X, 2080P0006X
PAMD062249L208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016545000004Medicaid
NJ7313501Medicaid
NJ7313501Medicaid
NJ012073Medicare ID - Type Unspecified
PA001654500Medicaid