Healthcare Provider Details

I. General information

NPI: 1053528158
Provider Name (Legal Business Name): KAREN A BURCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 980509
RICHMOND VA
23298-0509
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8786
  • Fax: 804-828-5775
Mailing address:
  • Phone: 804-828-9726
  • Fax: 804-828-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116017243
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: