Provider Demographics
NPI:1699772798
Name:BURDETTE, REBECCA G (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:BURDETTE
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:WOMENS HEALTH SPECIALISTS OF YORK LTD
Mailing Address - Street 2:310 PINE GROVE COMMONS
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-747-0713
Mailing Address - Fax:717-747-9114
Practice Address - Street 1:WOMENS HEALTH SPECIALISTS OF YORK LTD
Practice Address - Street 2:310 PINE GROVE COMMONS
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-747-0713
Practice Address - Fax:717-747-9114
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058708L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31701Medicare UPIN
PA876185Medicare ID - Type Unspecified