Healthcare Provider Details

I. General information

NPI: 1952693509
Provider Name (Legal Business Name): MR. RYAN MICHAEL BURG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

IV. Provider business mailing address

5118 KEINERS LN
PITTSBURGH PA
15205-9605
US

V. Phone/Fax

Practice location:
  • Phone: 412-963-6200
  • Fax:
Mailing address:
  • Phone: 412-429-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPI112515
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI112515
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: