Provider Demographics
NPI:1619205564
Name:BURCH, CORWIN S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CORWIN
Middle Name:S
Last Name:BURCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:CORY
Other - Middle Name:S
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1100 VIRGINIA ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1439
Mailing Address - Country:US
Mailing Address - Phone:206-621-1116
Mailing Address - Fax:206-621-0406
Practice Address - Street 1:1100 VIRGINIA ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1439
Practice Address - Country:US
Practice Address - Phone:206-621-1116
Practice Address - Fax:206-621-0406
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60118263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU56681Medicare UPIN