Provider Demographics
NPI:1235227158
Name:BURG, RICHARD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:BURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MAPLE AVE
Mailing Address - Street 2:SUITE C, 4TH FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4710
Mailing Address - Country:US
Mailing Address - Phone:914-949-0760
Mailing Address - Fax:914-681-0039
Practice Address - Street 1:170 MAPLE AVE
Practice Address - Street 2:SUITE C, 4TH FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4710
Practice Address - Country:US
Practice Address - Phone:914-949-0760
Practice Address - Fax:914-681-0039
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111819208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWS864OtherOXFORD
NY714935OtherUNITEDHEALTHCARE
NY624031OtherBCBS
NY9563949007OtherCIGNA
NY00325535Medicaid
NY4203251OtherAETNA
NYWP0016OtherHEALTHNET
NY9563949007OtherCIGNA
NY714935OtherUNITEDHEALTHCARE