MEDICARE: DR. RICHARD ELY BURGESS M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084V0102X	Vascular Neurology Physician	MD035372	DC
2	2084V0102X	Vascular Neurology Physician	D63053	MD
3	2084V0102X	Vascular Neurology Physician	036133825	IL
4	2084N0400X	Neurology Physician	35.098756	OH
5	2084V0102X	Vascular Neurology Physician	35.098756	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649340530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ELY BURGESS M.D., PH.D.

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-5023
Fax Number	:	419-383-6235

Provider Business Practice Location Address
First Line	:	2130 W CENTRAL AVE STE 102103
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3818
Country	:	US
Telephone Number	:	419-291-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	10/31/2025

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