Provider Demographics
NPI:1861442014
Name:BURCKHARTT, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BURCKHARTT
Suffix:
Gender:F
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-445-8242
Mailing Address - Fax:251-445-8250
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:BLDG. C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-445-8242
Practice Address - Fax:251-445-8250
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16748207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009904845Medicaid
AL009906905Medicaid
LA1538558Medicaid
MS00119629Medicaid
AL51512534OtherBCBS
AL51518570OtherBCBS
AL25-10764OtherUNITED HEALTHCARE
FL265551900Medicaid
FL265551900Medicaid
F36422Medicare UPIN
AL009906905Medicaid