Individual
DR. KENNETH DAVID BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
3845 SOUTH NEW HOPE ROAD, GASTONIA, NC 28056
(704) 824-9119
(704) 824-2401
Mailing address
PO BOX 551178, GASTONIA, NC 28055-1178
(704) 824-9119
(704) 824-2401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32655
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19982
BCBS
NC
01
—
205144C
MEDICARE PTAN#
NC
05
—
8919982
—
NC
01
—
P00297412
PALMETTO GBA
NC
Enumeration date
01/03/2006
Last updated
07/14/2008
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