1629932553 NPI number — FLETCHER GORDON BURCH

Table of content: FLETCHER GORDON BURCH (NPI 1629932553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629932553 NPI number — FLETCHER GORDON BURCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURCH
Provider First Name:
FLETCHER
Provider Middle Name:
GORDON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629932553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5982 RHODES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44240-8100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-673-1347
Provider Business Mailing Address Fax Number:
330-678-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 WOLF LEDGES PKWY STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44311-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-298-8710
Provider Business Practice Location Address Fax Number:
234-571-0107
Provider Enumeration Date:
12/15/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)