Provider Demographics
NPI:1730055583
Name:BURCH, CARL
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:BURCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OAK LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9347
Mailing Address - Country:US
Mailing Address - Phone:267-691-9775
Mailing Address - Fax:267-691-9775
Practice Address - Street 1:4 OAK LN
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9347
Practice Address - Country:US
Practice Address - Phone:267-691-9775
Practice Address - Fax:267-691-9775
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor