Healthcare Provider Details

I. General information

NPI: 1649340530
Provider Name (Legal Business Name): RICHARD ELY BURGESS M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVENUE, #101, #102, #103
TOLEDO OH
43606-3818
US

IV. Provider business mailing address

3000 ARLINGTON AVE STOP 1108
TOLEDO OH
43614-2595
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax: 419-479-6055
Mailing address:
  • Phone: 419-383-5322
  • Fax: 419-383-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.098756
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number4301116456
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35.098756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: