Provider Demographics
NPI:1790368389
Name:BURKHART, DANIEL CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHARLES
Last Name:BURKHART
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 N HIGH ST STE 155
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1409
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:
Practice Address - Street 1:8351 N HIGH ST STE 155
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1409
Practice Address - Country:US
Practice Address - Phone:614-664-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006956RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant