Provider Demographics
NPI:1497921597
Name:BURNSIDE, ROBERT D (CST/CFA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:BURNSIDE
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SCHENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-2144
Mailing Address - Country:US
Mailing Address - Phone:330-755-6992
Mailing Address - Fax:330-747-0491
Practice Address - Street 1:540 PARMALEE AVE STE 410
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1605
Practice Address - Country:US
Practice Address - Phone:330-747-1106
Practice Address - Fax:330-747-0491
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH92233246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant