Provider Demographics
NPI:1922045186
Name:BURGHER, CHARLES JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JEFFREY
Last Name:BURGHER
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-578-3400
Mailing Address - Fax:859-957-0055
Practice Address - Street 1:334 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3464
Practice Address - Country:US
Practice Address - Phone:859-578-3400
Practice Address - Fax:859-957-0055
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36645208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64042849Medicaid
P00812086OtherRAILROAD MEDICARE
KY110223258OtherRAILROAD MEDICARE
OH2275309Medicaid
KY110223258OtherRAILROAD MEDICARE
KY64042849Medicaid
KY0672701Medicare PIN
KY0403728Medicare PIN