Provider Demographics
NPI:1619198900
Name:BURKHOLDER, DAVID U (MED, PC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:U
Last Name:BURKHOLDER
Suffix:
Gender:M
Credentials:MED, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 PORTAGE POINTE DR
Mailing Address - Street 2:SUITE C102
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5609
Mailing Address - Country:US
Mailing Address - Phone:740-398-0872
Mailing Address - Fax:
Practice Address - Street 1:520 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2218
Practice Address - Country:US
Practice Address - Phone:330-296-5552
Practice Address - Fax:330-296-6126
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC8439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional