Provider Demographics
NPI:1629004072
Name:BURNS MD AND HAGE MD PC
Entity Type:Organization
Organization Name:BURNS MD AND HAGE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-947-4545
Mailing Address - Street 1:7020 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9306
Mailing Address - Country:US
Mailing Address - Phone:716-947-4545
Mailing Address - Fax:716-947-6146
Practice Address - Street 1:7020 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9306
Practice Address - Country:US
Practice Address - Phone:716-947-4545
Practice Address - Fax:716-947-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0867Medicare PIN