Provider Demographics
NPI:1396763405
Name:BURCH, WILLIAM (MD, MSE, BEE)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BURCH
Suffix:
Gender:M
Credentials:MD, MSE, BEE
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 134
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-0134
Mailing Address - Country:US
Mailing Address - Phone:267-231-3051
Mailing Address - Fax:215-477-5440
Practice Address - Street 1:2305 N BROAD ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-4504
Practice Address - Country:US
Practice Address - Phone:215-229-2022
Practice Address - Fax:215-229-6747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013724E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABB8177152OtherDEA REGISTRATION NUMBER