Healthcare Provider Details

I. General information

NPI: 1164626032
Provider Name (Legal Business Name): MARY BURKHARDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BEEKMAN ST.
CINCINNATI OH
45225
US

IV. Provider business mailing address

2750 BEEKMAN ST.
CINCINNATI OH
45225
US

V. Phone/Fax

Practice location:
  • Phone: 513-517-2000
  • Fax: 513-517-2022
Mailing address:
  • Phone: 513-517-2000
  • Fax: 513-517-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.094281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: