Provider Demographics
NPI:1861498321
Name:BURNS, RICHARD JOHN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SPRUCE ST
Mailing Address - Street 2:STE 609
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1409
Mailing Address - Country:US
Mailing Address - Phone:570-961-3700
Mailing Address - Fax:570-343-6088
Practice Address - Street 1:321 SPRUCE ST
Practice Address - Street 2:STE 609
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1409
Practice Address - Country:US
Practice Address - Phone:570-961-3700
Practice Address - Fax:570-343-6088
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008562-L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017112680006Medicaid
PA016809Medicare ID - Type Unspecified
PA0017112680006Medicaid