Provider Demographics
NPI:1275521676
Name:BURKHART, PATRICK HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:HENRY
Last Name:BURKHART
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 1:1702 E LAMAR ALEX PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-6204
Mailing Address - Country:US
Mailing Address - Phone:865-977-0555
Mailing Address - Fax:865-681-0963
Practice Address - Street 1:1702 E LAMAR ALEX PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-6204
Practice Address - Country:US
Practice Address - Phone:865-977-0555
Practice Address - Fax:865-681-0963
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010267207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0014376OtherBLUE CROSS
TN100021263OtherPHP TENNCARE
TN2569651OtherCIGNA
TN702002105OtherCARITEN
TNTN0067682OtherTRICARE
TN070000089OtherRAILROAD MEDICARE
TN702002105OtherCARITEN
TN3185253Medicare ID - Type Unspecified1C