Provider Demographics
NPI:1033225321
Name:BURDICK, RALPH EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWARD
Last Name:BURDICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:DELAWARE CITY
Mailing Address - State:DE
Mailing Address - Zip Code:19706-0300
Mailing Address - Country:US
Mailing Address - Phone:302-834-3600
Mailing Address - Fax:302-834-9473
Practice Address - Street 1:126 CLINTON ST
Practice Address - Street 2:
Practice Address - City:DELAWARE CITY
Practice Address - State:DE
Practice Address - Zip Code:19706-7706
Practice Address - Country:US
Practice Address - Phone:302-834-3600
Practice Address - Fax:302-834-9473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20001890208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000156703Medicaid
DE403672Medicare PIN
DE0000156703Medicaid