Provider Demographics
NPI:1164626032
Name:BURKHARDT, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BURKHARDT
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 1:2750 BEEKMAN ST.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225
Mailing Address - Country:US
Mailing Address - Phone:513-517-2000
Mailing Address - Fax:513-517-2022
Practice Address - Street 1:2750 BEEKMAN ST.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225
Practice Address - Country:US
Practice Address - Phone:513-517-2000
Practice Address - Fax:513-517-2022
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics