Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS023805L | PA |
Y | 213EG0000X | General Practice | DS023805L | PA |
NPI | 1003020132 |
---|---|
Provider Name | Dr. Thomas Richard Bursich |
First Address | Erie, PA 16505-5513 |
Second Address | Mc Kean, PA 16426-1454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |