=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700866860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE A BURKHARDT D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2006
-----------------------------------------------------
Last Update Date | 06/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 S PLEASANT AVE
-----------------------------------------------------
City | DALLASTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17313-9252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-851-1300
-----------------------------------------------------
Fax | 717-851-1310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3421 CONCORD RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-9001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-851-1300
-----------------------------------------------------
Fax | 717-851-1310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS008275L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------