Provider Demographics
NPI:1861483125
Name:BURGESS, JUDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:BURGESS
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 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:215-473-1515
Mailing Address - Fax:215-473-1515
Practice Address - Street 1:1 W ELM ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2007
Practice Address - Country:US
Practice Address - Phone:610-567-6964
Practice Address - Fax:610-567-6170
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0809734000OtherKEYSTONE HEALTH PLAN EAST
PA0015279820006Medicaid
PA1023774OtherKEYSTONE MERCY
PA5065448OtherAETNA PPO
PA0543935OtherAETNA HMO
PA5065448OtherAETNA PPO
PA0543935OtherAETNA HMO