Individual provider · NPI-1

Michelle R Burdette, MD, Retired

Family Medicine · South Charleston, WV

NPI number1649274044
StatusActive
Last updated in NPPESDec 13, 2022

Details

NPI
1649274044
Entity type
Individual (NPI-1)
Name
Michelle R Burdette
Credential
MD, Retired
Sex
Female
Sole proprietor
No
Enumeration date
Jun 13, 2005
Certification date
Dec 13, 2022
Last updated
Dec 13, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine16928WVYes

Practice location

4605 Maccorkle Ave Sw
South Charleston, WV 25309-1311

Phone 304-414-4800

Mailing address

4605 Maccorkle Ave Sw
South Charleston, WV 25309-1311

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