Individual
CHANELE M BURGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
212 HIGHBRIDGE ST C, FAYETTEVILLE, NY 13066-1981
(315) 637-0477
(315) 637-0559
Mailing address
212 HIGHBRIDGE ST C, FAYETTEVILLE, NY 13066-1981
(315) 637-0477
(315) 637-0559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
217557
NY
Other
Enumeration date
12/29/2005
Last updated
10/08/2015
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