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General NPI Number Information
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NPI Number | 1649340530
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Entity Type | Individual
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Provider Name | RICHARD ELY BURGESS M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 2130 W CENTRAL AVE STE 102103
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City | TOLEDO
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State | OH
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Zip | 43606-3818
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Country | US
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Telephone | 419-291-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 ARLINGTON AVE STOP 1108
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City | TOLEDO
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State | OH
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Zip | 43614-2595
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Country | US
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Telephone | 419-383-5023
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Fax | 419-383-6235
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | MD035372
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | D63053
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 036133825
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 35.098756
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 35.098756
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License Number State | OH
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