Healthcare Provider Details

I. General information

NPI: 1528193968
Provider Name (Legal Business Name): JOHN WILLIAM BURCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 JOHN ST
WEST HENRIETTA NY
14586-9790
US

IV. Provider business mailing address

24 WHITECLIFF DR
PITTSFORD NY
14534-2928
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-5610
  • Fax: 585-760-5509
Mailing address:
  • Phone: 585-760-5610
  • Fax: 585-760-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number159783-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: