Provider Demographics
NPI:1740348838
Name:BURLINGTON MEDICAL PRACTICE, PA
Entity type:Organization
Organization Name:BURLINGTON MEDICAL PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-584-5200
Mailing Address - Street 1:1183 UNIVERSITY DR
Mailing Address - Street 2:SUITE 105-410
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8303
Mailing Address - Country:US
Mailing Address - Phone:336-584-5200
Mailing Address - Fax:336-584-0099
Practice Address - Street 1:1248 HUFFMAN MILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-584-5200
Practice Address - Fax:336-584-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600215174400000X
NC200600619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC199001OtherWELLPATH
NC7761536OtherAETNA
NCXXXXXX944OtherUHC---MEDICARE COMPLETE
NC346879OtherGREAT WEST
NC018KUOtherBCBS
NC6579469OtherCIGNA
NC891037PMedicaid
NCC8899OtherMEDCOST
NC018KUOtherBCBS
NC=========OtherCORVEL
NC=========OtherHEALTHCARE SAVINGS
NCC8899OtherMEDCOST
NC891037PMedicaid
NC7761536OtherAETNA
NC=========OtherTRICARE FOR LIFE
NC=========OtherKEY RISK