Provider Demographics
NPI:1184228116
Name:BURDEN, GARY
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:BURDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:OH
Mailing Address - Zip Code:44234-0272
Mailing Address - Country:US
Mailing Address - Phone:561-512-3762
Mailing Address - Fax:
Practice Address - Street 1:10485 STATE ROUTE 700
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9741
Practice Address - Country:US
Practice Address - Phone:561-512-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty