Provider Demographics
NPI:1992761068
Name:BURG, CAROL G (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:G
Last Name:BURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-524-4009
Mailing Address - Fax:216-524-7933
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-524-4009
Practice Address - Fax:216-524-7933
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35045077207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000192649OtherANTHEM
OHP00131656OtherRAILROAD MEDICARE-SAG
OH0527746Medicaid
OHT45077OtherAPEX-SUMMACARE
OH101091OtherKAISER
OH101091OtherKAISER
C02606Medicare UPIN
OHT45077OtherAPEX-SUMMACARE