Provider Demographics
NPI:1013080670
Name:GINSBERG, BURTON (DO)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:GINSBERG
Suffix:
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 1:78 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3646
Mailing Address - Country:US
Mailing Address - Phone:610-409-9999
Mailing Address - Fax:610-409-8470
Practice Address - Street 1:78 SECOND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3646
Practice Address - Country:US
Practice Address - Phone:610-409-9999
Practice Address - Fax:610-409-8470
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002647L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD66388Medicare UPIN