Healthcare Provider Details

I. General information

NPI: 1457489510
Provider Name (Legal Business Name): GREGORY JOHN BURKLAND N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ALLEN ST
RUTLAND VT
05701-4501
US

IV. Provider business mailing address

91 EAST STREET
RUTLAND VT
05701
US

V. Phone/Fax

Practice location:
  • Phone: 802-922-6171
  • Fax:
Mailing address:
  • Phone: 802-922-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-0000203
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: