Provider Demographics
NPI:1477749208
Name:BURBRIDGE, MARK THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:BURBRIDGE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9313 MEDICAL PLAZA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9802
Mailing Address - Country:US
Mailing Address - Phone:843-790-8280
Mailing Address - Fax:843-974-8500
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 103
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9802
Practice Address - Country:US
Practice Address - Phone:843-790-8280
Practice Address - Fax:843-974-8500
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC36500207RH0003X, 207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC365009Medicaid