Provider Demographics
NPI:1659374882
Name:BURACK, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BURACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:744 ARDEN LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2984
Mailing Address - Country:US
Mailing Address - Phone:803-329-1660
Mailing Address - Fax:803-329-4118
Practice Address - Street 1:744 ARDEN LN
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2984
Practice Address - Country:US
Practice Address - Phone:803-329-1660
Practice Address - Fax:803-329-4118
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14896174400000X, 207RR0500X
NC39768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC148968Medicaid
SC1659374882OtherBLUE CROSS BLUE SHIELD
NC19906OtherBLUE CROSS BLUE SHIELD
NCNC8919906Medicaid
C27881Medicare UPIN
NCNC8919906Medicaid
NC2156835BMedicare PIN