Provider Demographics
NPI:1487659223
Name:BURTON, MARK E (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:BURTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREEN LN
Mailing Address - Street 2:STE 2
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5600
Mailing Address - Country:US
Mailing Address - Phone:215-785-5366
Mailing Address - Fax:215-788-0645
Practice Address - Street 1:100 GREEN LN
Practice Address - Street 2:STE 2
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-5600
Practice Address - Country:US
Practice Address - Phone:215-785-5366
Practice Address - Fax:215-788-0645
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003078L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010922120009Medicaid
PAT30230Medicare UPIN
PA408523KCSMedicare ID - Type Unspecified