Provider Demographics
NPI:1467478776
Name:BURACK, WALTER R (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:R
Last Name:BURACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:601 ELMWOOD AVENUE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-1885
Mailing Address - Fax:585-276-2047
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 626
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-1885
Practice Address - Fax:585-276-2047
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-07-05
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Provider Licenses
StateLicense IDTaxonomies
NY243435207ZP0105X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB5722Medicare PIN
H02501Medicare UPIN