Provider Demographics
NPI:1710944186
Name:BURGE, HOLLY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JEAN
Last Name:BURGE
Suffix:
Gender:F
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:PO BOX 19368
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-9368
Mailing Address - Country:US
Mailing Address - Phone:919-787-8221
Mailing Address - Fax:919-789-4461
Practice Address - Street 1:3949 BROWNING PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6504
Practice Address - Country:US
Practice Address - Phone:919-787-8221
Practice Address - Fax:919-789-4461
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311162085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC63146OtherMEDCOST
NC8920047Medicaid
NC16-54696OtherUNITED HEALTHCARE
NC20047OtherBLUECROSS BLUESHIELD
NC49972OtherMEDCOST
NC16-54697OtherUNITED HEALTHCARE
NC16-54698OtherUNITED HEALTHCARE
NC63174OtherMEDCOST
NC8920047Medicaid
NC16-54696OtherUNITED HEALTHCARE
NCE40650Medicare UPIN
NC2153883BMedicare ID - Type Unspecified