Provider Demographics
NPI:1164724027
Name:BURK, MARLENE J (LAC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:J
Last Name:BURK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 COOPERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3721
Mailing Address - Country:US
Mailing Address - Phone:610-613-9248
Mailing Address - Fax:
Practice Address - Street 1:921 COOPERTOWN RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3721
Practice Address - Country:US
Practice Address - Phone:610-613-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist