Provider Demographics
NPI:1508142696
Name:BURGE, DANIELLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BURGE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DIMARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:501 YORK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2142
Mailing Address - Country:US
Mailing Address - Phone:610-331-5439
Mailing Address - Fax:
Practice Address - Street 1:501 YORK RD STE 4
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2142
Practice Address - Country:US
Practice Address - Phone:610-331-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered