MEDICARE: DR. JOHN WILLIAM BURCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	159783-1	NY

General Provider Information

NPI Number	:	1528193968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM BURCH MD

Provider Business Mailing Address
First Line	:	24 WHITECLIFF DR
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-2928
Country	:	US
Telephone Number	:	585-760-5610
Fax Number	:	585-760-5509

Provider Business Practice Location Address
First Line	:	825 JOHN ST
Second Line	:
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-9790
Country	:	US
Telephone Number	:	585-760-5610
Fax Number	:	585-760-5509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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