Provider Demographics
NPI:1437245644
Name:BUERK, ELLEN PLUMMER (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:PLUMMER
Last Name:BUERK
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 1:5141 MORNING SUN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056
Mailing Address - Country:US
Mailing Address - Phone:513-523-2156
Mailing Address - Fax:513-523-2503
Practice Address - Street 1:5141 MORNING SUN RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056
Practice Address - Country:US
Practice Address - Phone:513-523-2156
Practice Address - Fax:513-523-2503
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35030957208000000X
IN01031865A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000010540OtherANTHEM BCBS
OH0185571Medicaid
IN000000010540OtherANTHEM BCBS
IN100349450Medicaid