Healthcare Provider Details

I. General information

NPI: 1952371478
Provider Name (Legal Business Name): GREGORY BURKHARD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 FARBER HALL SUNY @ BUFFALO SPORTS MEDICINE
BUFFALO NY
14214-8001
US

IV. Provider business mailing address

160 FARBER HALL SUNY @ BUFFALO SPORTS MEDICINE
BUFFALO NY
14214-8001
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3670
  • Fax:
Mailing address:
  • Phone: 716-829-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: