Provider Demographics
NPI:1992771687
Name:BURDGE, KELLY A (MD)
Entity type:Individual
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First Name:KELLY
Middle Name:A
Last Name:BURDGE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:104 ENDICOTT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-882-6700
Mailing Address - Fax:978-646-8553
Practice Address - Street 1:104 ENDICOTT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-882-6700
Practice Address - Fax:978-646-8553
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-02-29
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Provider Licenses
StateLicense IDTaxonomies
MA238168207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD247072OtherMIDLANDS CHOICE
MN341G8BUOtherBLUE CROSS
SD4994483OtherBLUE CROSS
SD3100277OtherMEDICA
SD2364662OtherARAZ/ AMERICA'S PPO
MN341G8BUOtherCC SYSTEMS/ BLUE PLUS
SD45364OtherSANFORD HEALTH PLAN
SD57105P008OtherWPS TRICARE
IA0594705Medicaid
NE46022474344Medicaid
SD5561OtherDAKOTACARE
MN934628700Medicaid
SDP00368122OtherRR MEDICARE
SD370624200OtherDEPT OF LABOR
SD406751043656OtherPREFERRED ONE
SDHP52482OtherHEALTHPARTNERS
ND12903Medicaid
SD6631200Medicaid
NE46022474344Medicaid
SDS100433Medicare PIN