Provider Demographics
NPI:1467544544
Name:BURCHETT, TROY LINCOLN (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:LINCOLN
Last Name:BURCHETT
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 1:37 10TH AVE
Mailing Address - Street 2:SOUTHERN SHORES
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-9013
Mailing Address - Country:US
Mailing Address - Phone:252-261-6380
Mailing Address - Fax:
Practice Address - Street 1:37 TENTH AVE.
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-9013
Practice Address - Country:US
Practice Address - Phone:252-261-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13881208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC64641Medicare UPIN