Provider Demographics
NPI:1598712119
Name:BURLEW, BRIAN PRENTICE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PRENTICE
Last Name:BURLEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:5325 NORTHGATE DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-625-8898
Practice Address - Fax:610-625-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037049E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA91964OtherUNISON
PAP867065OtherOXFORD
PA020055700OtherBLACK LUNG
PABU608961OtherPA BLUE SHIELD
PA290009012OtherRAILROAD MEDICARE
PA4273808OtherAETNA
PA0012094500002Medicaid
PA01182701OtherCAPITAL BLUE CROSS
PA0012094500002Medicaid
PA4273808OtherAETNA