Provider Demographics
NPI:1457308520
Name:BURNS, ILENE T (MD)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:T
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 WATERCREST WAY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1370
Mailing Address - Country:US
Mailing Address - Phone:724-274-9451
Mailing Address - Fax:724-274-9370
Practice Address - Street 1:5769 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-3211
Practice Address - Country:US
Practice Address - Phone:412-793-8870
Practice Address - Fax:412-793-9290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD044668L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA770842OtherHIGHMARK
PA0015133880001Medicaid
PA0015133880001Medicaid
PA770842Medicare ID - Type Unspecified