Provider Demographics
NPI:1134177603
Name:BURDETTE, LENA CLAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:CLAIRE
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LENA
Other - Middle Name:CLAIRE
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 BUSHWOOD CT APT 2408
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8189
Mailing Address - Country:US
Mailing Address - Phone:303-518-3801
Mailing Address - Fax:
Practice Address - Street 1:200 BUSHWOOD CT APT 2408
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8189
Practice Address - Country:US
Practice Address - Phone:303-518-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43230208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59999Medicare UPIN