Provider Demographics
NPI:1447333240
Name:BURKHART, BRIAN PAUL (AUD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PAUL
Last Name:BURKHART
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RIDGE GATE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8616
Mailing Address - Country:US
Mailing Address - Phone:336-946-0689
Mailing Address - Fax:
Practice Address - Street 1:2827 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4145
Practice Address - Country:US
Practice Address - Phone:336-765-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2400231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2521029Medicare ID - Type Unspecified