Provider Demographics
NPI:1922028430
Name:BURGDORF, ROSELLA O (NP)
Entity Type:Individual
Prefix:
First Name:ROSELLA
Middle Name:O
Last Name:BURGDORF
Suffix:
Gender:F
Credentials:NP
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:24 GLOUCESTER ROAD
Practice Address - Street 2:UVA STUARTS DRAFT FAMILY PRACTICE
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477
Practice Address - Country:US
Practice Address - Phone:540-337-3710
Practice Address - Fax:570-337-0930
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001049059207Q00000X
VA0024049059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010229120Medicaid
VA010229120Medicaid
VAC01946Medicare PIN
VA010462U92Medicare PIN