Provider Demographics
NPI:1528026986
Name:ZORN, BURKHARDT H (MD)
Entity Type:Individual
Prefix:
First Name:BURKHARDT
Middle Name:H
Last Name:ZORN
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 1:311 W 24TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2668
Mailing Address - Country:US
Mailing Address - Phone:814-452-4214
Mailing Address - Fax:814-459-7823
Practice Address - Street 1:311 W 24TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2668
Practice Address - Country:US
Practice Address - Phone:814-452-4214
Practice Address - Fax:814-459-7823
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044297208800000X
PAMD036948E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD922301100Medicaid
MD922301100Medicaid
MDG01867C03Medicare ID - Type Unspecified
MD922301100Medicaid
MD335545YYA6Medicare PIN
MD004705YF1DMedicare PIN