Healthcare Provider Details

I. General information

NPI: 1548559628
Provider Name (Legal Business Name): BRIAN WESLEY BURKHART MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 GLENDALE DR SW
WILSON NC
27893-4678
US

IV. Provider business mailing address

1704 GLENDALE DR SW
WILSON NC
27893-4678
US

V. Phone/Fax

Practice location:
  • Phone: 252-246-8960
  • Fax: 252-246-8961
Mailing address:
  • Phone: 252-246-8960
  • Fax: 252-246-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2014-00620
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-00620
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: