Provider Demographics
NPI:1780650689
Name:BURCH, STEPHANIE A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:BURCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6 SAN REMO DR.
Mailing Address - Street 2:UVM MEDICAL CENTER, DEPT. OF ORTHOPEDICS/SAN REMO
Mailing Address - City:S. BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-862-3983
Mailing Address - Fax:802-863-7994
Practice Address - Street 1:6 SAN REMO DR.
Practice Address - Street 2:UVM MEDICAL CENTER, DEPT. OF ORTHOPEDICS/SAN REMO
Practice Address - City:S. BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-862-3983
Practice Address - Fax:802-863-7994
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031322363A00000X
PAMA052227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052227OtherLICENSE
PA100121NH3Medicare PIN
PA067522Medicare UPIN