Provider Demographics
NPI:1326050113
Name:BURBANK, KELTON M (MD)
Entity Type:Individual
Prefix:DR
First Name:KELTON
Middle Name:M
Last Name:BURBANK
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 1:67 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-1305
Mailing Address - Country:US
Mailing Address - Phone:978-534-6333
Mailing Address - Fax:978-840-0866
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 3C
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-534-6333
Practice Address - Fax:978-840-0866
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79082207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61576Medicare UPIN