Provider Demographics
NPI:1265493845
Name:BURKERT, THOMAS SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:BURKERT
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 1:205 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2026
Mailing Address - Country:US
Mailing Address - Phone:330-757-8941
Mailing Address - Fax:330-757-8794
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2026
Practice Address - Country:US
Practice Address - Phone:330-757-8941
Practice Address - Fax:330-757-8794
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-8204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH251972Medicaid
OHG25542Medicare UPIN
OH251972Medicaid