Provider Demographics
NPI:1063482214
Name:BURCH, ANDREA S (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:BURCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 GREENE WAY STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4097
Mailing Address - Country:US
Mailing Address - Phone:502-806-3376
Mailing Address - Fax:502-213-3999
Practice Address - Street 1:2307 GREENE WAY STE C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4097
Practice Address - Country:US
Practice Address - Phone:502-806-3376
Practice Address - Fax:502-213-3999
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44924207N00000X
KY40176207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65785Medicare UPIN
KYK195811Medicare PIN
KY0754905Medicare PIN