Provider Demographics
NPI:1184738965
Name:BURCHETT, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BURCHETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3062
Mailing Address - Country:US
Mailing Address - Phone:859-745-7700
Mailing Address - Fax:859-745-7733
Practice Address - Street 1:455 BULLION BLVD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2933
Practice Address - Country:US
Practice Address - Phone:859-745-7700
Practice Address - Fax:859-745-7733
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY21227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212277Medicaid
KY1594401Medicare ID - Type Unspecified
C65456Medicare UPIN