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Individual
THEODORE BURDEN
Active
Individual
THEODORE BURDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD020774E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000804021
—
PA
01
—
0054331000
INDEPENDENCE BLUE CROSS
PA
01
—
1019558
KEYSTONE MERCY HEALTH
PA
01
—
128306
HIGHMARK BLUE SHIELD
PA
01
—
597586
MEDICARE GROUP
PA
01
—
CD4829
RAILROAD MEDICARE TPI GROUP
PA
01
—
P00037862
RAILROAD MEDICARE
PA
Enumeration date
08/23/2005
Last updated
07/18/2011
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