Provider Demographics
NPI:1548233083
Name:BURKHARDT, BARRY HERBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:HERBERT
Last Name:BURKHARDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W LANCASTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1749
Mailing Address - Country:US
Mailing Address - Phone:610-644-2382
Mailing Address - Fax:610-644-7517
Practice Address - Street 1:209 W LANCASTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1749
Practice Address - Country:US
Practice Address - Phone:610-644-2382
Practice Address - Fax:610-644-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAB8176934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019687Medicare ID - Type Unspecified
PAD77320Medicare UPIN