Provider Demographics
NPI:1013137371
Name:GUMUSCU, BURAK (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BURAK
Middle Name:
Last Name:GUMUSCU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BREMO ROAD, MOB NORTH,
Mailing Address - Street 2:SUITE 703
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-281-8182
Mailing Address - Fax:804-281-8263
Practice Address - Street 1:5855 BREMO ROAD, MOB NORTH,
Practice Address - Street 2:SUITE 703
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-281-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5154208000000X
FLME1144292080P0207X
VA01012551532080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
FL007278700Medicaid
VAC06778OtherGROUP PTAN