Provider Demographics
NPI:1083896302
Name:BURTAINE, JEFFREY EDWARE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWARE
Last Name:BURTAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 S. 9TH STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235
Mailing Address - Country:US
Mailing Address - Phone:570-645-1000
Mailing Address - Fax:570-645-1001
Practice Address - Street 1:575 S. 9TH STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235
Practice Address - Country:US
Practice Address - Phone:570-645-1000
Practice Address - Fax:570-645-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 00165E2083P0500X
PAMD011765E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine