Provider Demographics
NPI:1851381339
Name:BURDGE, ERIC C (MD, PHD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:BURDGE
Suffix:
Gender:M
Credentials:MD, PHD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 WELLES ST STE 150
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4947
Mailing Address - Country:US
Mailing Address - Phone:570-283-2323
Mailing Address - Fax:570-283-1290
Practice Address - Street 1:190 WELLES ST
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4968
Practice Address - Country:US
Practice Address - Phone:570-283-2323
Practice Address - Fax:570-283-1290
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047349208600000X
MI4301086111208600000X
NY225395208600000X
ARE-75592086X0206X
PAMD4502502086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery