Provider Demographics
NPI:1225022858
Name:BURNS, CHARLES NICHOLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WASHINGTON AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3814
Mailing Address - Country:US
Mailing Address - Phone:570-941-0630
Mailing Address - Fax:570-230-0013
Practice Address - Street 1:501 S WASHINGTON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3814
Practice Address - Country:US
Practice Address - Phone:570-941-0630
Practice Address - Fax:570-230-0013
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019709E174400000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007978940002Medicaid
PA0900660001OtherMEDICARE DME
PA11762 6365OtherGEISINGER HEALTH PLAN
PA072965OtherFIRST PRIORITY HEALTH
PA34369OtherBLUE SHIELD
DC01042601OtherCAPITAL BLUE CROSS
PA20010385OtherAMERIHEALTH MERCY
PA000000075845OtherMEDPLUS
PA2Y1004OtherHEALTHNET
PA340009441OtherTRAVELER'S RAILROAD MEDIC
PA505911OtherAETNA US HEALTHCARE