Provider Demographics
NPI:1760540967
Name:RENEE BURDETT, MD PC
Entity Type:Organization
Organization Name:RENEE BURDETT, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR CEO
Authorized Official - Prefix:
Authorized Official - First Name:V
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BURDETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-670-5738
Mailing Address - Street 1:13649 OFFICE PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-670-5738
Mailing Address - Fax:703-670-8213
Practice Address - Street 1:13649 OFFICE PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-670-5738
Practice Address - Fax:703-670-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06328Medicare ID - Type Unspecified