Provider Demographics
NPI:1255442364
Name:BURGESS, VICTORIA C (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:BERKSHIRE MEDICAL CENTER EMERGENCY DEPT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-881-5427
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:631 B NORTH STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-499-2054
Practice Address - Fax:413-445-9174
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S76184Medicare UPIN
MAAP1018Medicare ID - Type Unspecified