Provider Demographics
NPI:1619978418
Name:BURCHELL, DEL A (MD)
Entity Type:Individual
Prefix:
First Name:DEL
Middle Name:A
Last Name:BURCHELL
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-341-7482
Practice Address - Street 1:334 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3464
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-341-7482
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20063174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
021036000OtherFEDERAL BLACK LUNG
OH0563466Medicaid
50006693OtherPASSPORT
KY64200637Medicaid
KYP00922863OtherRAIL ROAD MEDICARE
0420677OtherUNITED HEALTHCARE
637091OtherAETNA
000000044592OtherANTHEM
KY3313210Medicare PIN
000000044592OtherANTHEM
KY64200637Medicaid
KY3400144Medicare PIN
KYP00922863OtherRAIL ROAD MEDICARE
021036000OtherFEDERAL BLACK LUNG
C69146Medicare UPIN
0420677OtherUNITED HEALTHCARE