Provider Demographics
NPI:1821218140
Name:BURKHART, TIMOTHY MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARTIN
Last Name:BURKHART
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 1:1 AYRES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03804-5446
Mailing Address - Country:US
Mailing Address - Phone:207-438-5975
Mailing Address - Fax:
Practice Address - Street 1:1 AYRES CIRCLE
Practice Address - Street 2:NAVAL BRANCH HEALTH CLINIC PORTSMOUTH
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804-5000
Practice Address - Country:US
Practice Address - Phone:207-438-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING208100000X
VA01012370812083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101237081OtherSTATE MEDICAL LICENSE