Provider Demographics
NPI:1164440483
Name:BURAKGAZI-DALKILIC, EVREN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVREN
Middle Name:
Last Name:BURAKGAZI-DALKILIC
Suffix:
Gender:M
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 # 100
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:856-356-4924
Mailing Address - Fax:856-356-4793
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 215
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2445
Practice Address - Fax:856-964-0504
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA086785002084N0400X
VA01012387092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010233836Medicaid
VA010233836Medicaid
VAI47924Medicare UPIN
VA009365M85Medicare ID - Type UnspecifiedC03685