Provider Demographics
NPI:1841230356
Name:BURBRIDGE, GEOFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:R
Last Name:BURBRIDGE
Suffix:
Gender:M
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 710
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5070
Mailing Address - Fax:828-757-5939
Practice Address - Street 1:322 MULBERRY ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5702
Practice Address - Country:US
Practice Address - Phone:828-757-6400
Practice Address - Fax:828-757-6424
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130GKOtherBCBS
NC890130GKMedicaid
NC890130GKMedicaid
NC2010177Medicare ID - Type Unspecified