Provider Demographics
NPI:1902169808
Name:BURGE, MATTHEW STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:BURGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:645 MCQUEEN SMITH RD N STE 300
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7269
Practice Address - Country:US
Practice Address - Phone:334-747-2999
Practice Address - Fax:334-747-7276
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.36181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I936812OtherMEDICARE
AL204557Medicaid
AL511-97736OtherBCBS OF ALABAMA
1902169808OtherNPI
ALP01919417OtherRAILROAD MEDICARE
AL8841312OtherCIGNA
AL511-96290OtherBCBS OF ALABAMA
ALZ39181OtherVIVA HEALTH
AL204555Medicaid
Z39181OtherUPIN