Provider Demographics
NPI:1912954595
Name:BURDETT, MAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BURDETT
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 1:199 S HERLONG AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1186
Mailing Address - Country:US
Mailing Address - Phone:803-324-1800
Mailing Address - Fax:803-328-3831
Practice Address - Street 1:199 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-324-1800
Practice Address - Fax:803-328-3831
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29105208600000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC202660098OtherGAFFNEY HMA PHYSICIAN MANAGEMENT
SC20-2660098OtherDR. MAUREEN BURDETT
SCGP4558MedicaidDR. MAUREEN BURDETT
SCGP4558MedicaidDR. MAUREEN BURDETT
SC20-2660098OtherDR. MAUREEN BURDETT