Healthcare Provider Details

I. General information

NPI: 1659660686
Provider Name (Legal Business Name): GREGORY THOMAS BURG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC7041
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

408 PACIFIC AVE
PITTSBURGH PA
15221-4012
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-6771
  • Fax:
Mailing address:
  • Phone: 412-496-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35.125840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: