Healthcare Provider Details

I. General information

NPI: 1346458205
Provider Name (Legal Business Name): MICHAEL D. BURGARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST POTTER 3
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST POTTER 3
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3534
  • Fax: 401-444-3298
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD13679
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: