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General NPI Number Information
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NPI Number | 1649692765
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Entity Type | Individual
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Provider Name | MARK SAMUEL BURCH PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 3401 YORKSHIRE MEDICAL PARK
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City | LEXINGTON
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State | KY
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Zip | 40509-2513
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Country | US
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Telephone | 859-263-5140
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Fax | 859-263-5141
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Provider Business Mailing Address
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Address Line | 3480 YORKSHIRE MEDICAL PARK
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City | LEXINGTON
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State | KY
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Zip | 40509-1886
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Country | US
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Telephone | 859-263-5140
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Fax | 859-263-5141
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TC028
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 01781
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110007036
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2765
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License Number State | KY
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