Provider Demographics
NPI:1376749655
Name:BURKHART, PATRICIA HELENE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:HELENE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:360-782-3650
Mailing Address - Fax:360-782-3686
Practice Address - Street 1:2200 NW MYHRE ROAD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7681
Practice Address - Country:US
Practice Address - Phone:360-830-1101
Practice Address - Fax:360-830-1283
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1038672085R0202X
MN510662085R0202X
WAMD602897622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300004750Medicare PIN
MN300005608Medicare PIN