Healthcare Provider Details

I. General information

NPI: 1265936504
Provider Name (Legal Business Name): JONATHAN WILLIAM BURGEI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COVINGTON ST
YOUNGSTOWN OH
44510-1617
US

IV. Provider business mailing address

1001 COVINGTON ST
YOUNGSTOWN OH
44510-1617
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-3258
  • Fax: 330-480-4119
Mailing address:
  • Phone: 330-480-3258
  • Fax: 330-480-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34.014945
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: