Provider Demographics
NPI:1639763790
Name:BURGE, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BURGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-9452
Mailing Address - Country:US
Mailing Address - Phone:681-220-4272
Mailing Address - Fax:
Practice Address - Street 1:1768 RITTER DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9452
Practice Address - Country:US
Practice Address - Phone:681-220-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker