Provider Demographics
NPI:1396174025
Name:BURGE, MAGHAN (NP)
Entity type:Individual
Prefix:MRS
First Name:MAGHAN
Middle Name:
Last Name:BURGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 ROCK RIDGE LN
Mailing Address - Street 2:APT M
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5125
Mailing Address - Country:US
Mailing Address - Phone:580-504-1205
Mailing Address - Fax:
Practice Address - Street 1:7103 ROCK RIDGE LN
Practice Address - Street 2:APT M
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5125
Practice Address - Country:US
Practice Address - Phone:580-504-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily