Provider Demographics
NPI:1649692765
Name:BURCH, MARK SAMUEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:SAMUEL
Last Name:BURCH
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1886
Mailing Address - Country:US
Mailing Address - Phone:859-263-5140
Mailing Address - Fax:859-263-5141
Practice Address - Street 1:3401 YORKSHIRE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2513
Practice Address - Country:US
Practice Address - Phone:859-263-5140
Practice Address - Fax:859-263-5141
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2024-09-17
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Provider Licenses
StateLicense IDTaxonomies
KYTC028363A00000X
WV01781363A00000X
VA0110007036363A00000X
KYPA2765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant