Provider Demographics
NPI:1679752737
Name:BURNS, CHARLES (HIS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CARL LANDI CIR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-7751
Mailing Address - Country:US
Mailing Address - Phone:781-681-9100
Mailing Address - Fax:
Practice Address - Street 1:164 WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1727
Practice Address - Country:US
Practice Address - Phone:781-681-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1530950Medicaid