Provider Demographics
NPI:1699725861
Name:BURHANNA, AMY SCALLY (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SCALLY
Last Name:BURHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:217 N MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2165
Practice Address - Country:US
Practice Address - Phone:609-463-5440
Practice Address - Fax:609-463-9888
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072858207RC0000X
NJ25MA07285800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8622205Medicaid
NJ050578Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ8622205Medicaid