Healthcare Provider Details

I. General information

NPI: 1285936187
Provider Name (Legal Business Name): EDWARD JOHN BURKHARD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2010
Last Update Date: 11/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 BROOKHAVEN DR W
ALLENTOWN PA
18103-9696
US

IV. Provider business mailing address

1888 BROOKHAVEN DR W
ALLENTOWN PA
18103-9696
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-9384
  • Fax:
Mailing address:
  • Phone: 610-437-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD005676E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD005676E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: