Individual
JEREMY J BURDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3732 OLENTANGY RIVER RD, SUITE C, COLUMBUS, OH 43214-3449
(614) 451-0411
(614) 451-8037
Mailing address
3732 OLENTANGY RIVER RD, SUITE C, COLUMBUS, OH 43214-3449
(614) 451-0411
(614) 451-8037
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35-042744
OH
208200000X
Plastic Surgery Physician
35.042744
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000118889
ANTHEM PROVIDER ID
OH
05
—
0553753
—
OH
Enumeration date
12/01/2005
Last updated
08/30/2013
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