Basic Information
| Provider Information | |||||||||
| NPI: | 1467402404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURCHEL | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 SW 78TH AVE | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
| FaxNumber: | 9546256034 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 DOCTORS ST | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286759247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363723214 | ||||||||
| FaxNumber: | 3363721597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 09/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 18395 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8919976 | 05 | NC | MEDICAID | 19976 | 01 | NC | BLUE CROSS | OTHER | 930123583 | 01 | RAILROAD MEDICARE | OTHER |