Provider Demographics
NPI:1154475358
Name:BURCHARD, PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BURCHARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WYNDHURST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2489
Mailing Address - Country:US
Mailing Address - Phone:410-435-5909
Mailing Address - Fax:443-923-4525
Practice Address - Street 1:600 WYNDHURST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2489
Practice Address - Country:US
Practice Address - Phone:410-435-5909
Practice Address - Fax:443-923-4525
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4061098Medicaid
61-16552Medicare UPIN
MD4061098Medicaid
2022092Medicare UPIN
210193Medicare UPIN
MD073274Medicare UPIN
120686Medicare UPIN