Provider Demographics
NPI:1922050632
Name:BURCHENAL, DAVID HOLLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOLLAND
Last Name:BURCHENAL
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 1:213 ELM ST
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1165
Mailing Address - Country:US
Mailing Address - Phone:860-535-3245
Mailing Address - Fax:860-535-3246
Practice Address - Street 1:213 ELM ST
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-1165
Practice Address - Country:US
Practice Address - Phone:860-535-3245
Practice Address - Fax:860-535-3246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTZP208OtherOXFORD
P00090169OtherRAILROAD MEDICARE
CT010032153CT01OtherANTHEM BLUE CROSS
OV5772OtherHEALTHNET
RI409907OtherBLUE CHIP
RI231251OtherRI BLUE CROSS
0161014OtherCIGNA
2032340OtherAETNA
973603OtherUNITED HEALTHCARE
RI231251OtherRI BLUE CROSS