Andrea Lucile Burgo-Black, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

025451 Issued in CT

Practice address

950 Campbell Ave
Vact Healthcare System
West Haven, CT 06516-2770

Phone

(203) 932-5711

Fax

(203) 937-3403

NPI assigned

Sep 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Andrea Lucile Burgo Professional name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396843231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 KENTER PL",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065152412",
            "telephone_number": "203-389-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 CAMPBELL AVE",
            "address_2": "VACT HEALTHCARE SYSTEM",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065162770",
            "telephone_number": "203-932-5711",
            "fax_number": "203-937-3403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGO-BLACK",
        "first_name": "ANDREA",
        "middle_name": "LUCILE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "025451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "BURGO",
            "middle_name": "LUCILE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jennifer Bunk, PHARMD
• Ryan Burdick, DC
• Beth Ann Bureau, DDS
• Courtney Burgazli
• Nicholas Burge, PHARMD, BCPS
• Michael David Burkett, PHARMD, BCACP
• Adam Burkland
• Jessica Lindsay Burris, MD
• Jalissa Burton
• Kevin Burton, PHARM.D.

• Internal Medicine Physician in West Haven, CT
• Providers in West Haven, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.