Provider Demographics
NPI:1366523805
Name:BURG, ANDREW CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHARLES
Last Name:BURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20505 CRESCENT BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8825
Mailing Address - Country:US
Mailing Address - Phone:714-726-9565
Mailing Address - Fax:
Practice Address - Street 1:20505 CRESCENT BAY DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8825
Practice Address - Country:US
Practice Address - Phone:714-726-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43765207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A437650Medicaid
CAF21300Medicare UPIN
CA00A437650Medicaid
CAWA43765BMedicare PIN