Provider Demographics
NPI:1245231547
Name:BURKHOLDER, BURTON VON (MD)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:VON
Last Name:BURKHOLDER
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 1:320 WINDING RIVER LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3569
Mailing Address - Country:US
Mailing Address - Phone:434-296-0113
Mailing Address - Fax:434-293-2367
Practice Address - Street 1:320 WINDING RIVER LN
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3569
Practice Address - Country:US
Practice Address - Phone:434-296-0113
Practice Address - Fax:434-293-2367
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230390207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005900484Medicaid
VA212741OtherANTHEM
VA212741OtherANTHEM
VA070000325Medicare ID - Type Unspecified
VA212741OtherANTHEM