Provider Demographics
NPI:1225012370
Name:BURKERT, KELLY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:BURKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1761
Mailing Address - Country:US
Mailing Address - Phone:610-566-7846
Mailing Address - Fax:610-891-6735
Practice Address - Street 1:101 CHESLEY DR
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1761
Practice Address - Country:US
Practice Address - Phone:610-566-7846
Practice Address - Fax:610-891-6735
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89124207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1225012370OtherNPI
FL37321ZMedicare ID - Type Unspecified
FLI09575Medicare UPIN