Provider Demographics
NPI:1134163801
Name:MARK E BURTON, DPM PC
Entity type:Organization
Organization Name:MARK E BURTON, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-504-9266
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-0568
Mailing Address - Country:US
Mailing Address - Phone:215-504-9266
Mailing Address - Fax:215-504-8373
Practice Address - Street 1:603 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5528
Practice Address - Country:US
Practice Address - Phone:215-504-9266
Practice Address - Fax:215-504-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD9029OtherTRAVELERS MEDICARE
669858OtherHIGHMARK BLUE SHIELD
PA0255920001Medicare NSC
PA669858Medicare ID - Type Unspecified