Provider Demographics
NPI:1437101037
Name:BURGESS, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:BURGESS
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 1:1620 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5848
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:BLDG 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-348-2992
Practice Address - Fax:704-334-3061
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26089207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79-19989Medicaid
SC260890Medicaid
NCC83058Medicare UPIN
NC79-19989Medicaid
205145GMedicare PIN