Provider Demographics
NPI:1508866658
Name:BURSTYNOWICZ, LINDA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:BURSTYNOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5514
Mailing Address - Country:US
Mailing Address - Phone:724-430-6555
Mailing Address - Fax:724-430-6976
Practice Address - Street 1:111B ROBERTS RD
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1105
Practice Address - Country:US
Practice Address - Phone:724-785-2286
Practice Address - Fax:724-785-3187
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA071890L208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015441410015Medicaid
PA0018184240005Medicaid
PAP001930OtherGATEWAY
PA0110237825OtherRAILROAD MEDICARE
PA900236OtherHIGHMARK
PA131194OtherHEALTH AMERICA
PA215965OtherUPMC
PA112333OtherMEDPLUS
PAH22360Medicare UPIN
PA0015441410015Medicaid