Provider Demographics
NPI:1528554862
Name:BURDGE, ANTHONY TODD (LPT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TODD
Last Name:BURDGE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 CUTTING BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-2554
Mailing Address - Country:US
Mailing Address - Phone:510-232-0874
Mailing Address - Fax:510-232-8652
Practice Address - Street 1:1313 CUTTING BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2554
Practice Address - Country:US
Practice Address - Phone:510-232-0874
Practice Address - Fax:510-232-8652
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38144167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician