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General NPI Number Information
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NPI Number | 1861609042
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Entity Type | Organization
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Legal Business Name | BETH CADY BURGHARDT MD PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 5100 W TAFT RD SUITE 4L
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-452-2124
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Fax | 315-452-2128
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Provider Business Mailing Address
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Address Line | 5100 W TAFT RD SUITE 4L
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-452-2124
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Fax | 315-452-2128
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETH MICHELLE BURGHARDT
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Credential | MD
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Telephone | 315-452-2124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 185289
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License Number State | NY
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