Provider Demographics
NPI:1457374654
Name:BURLAS, REGIS P (DO)
Entity type:Individual
Prefix:
First Name:REGIS
Middle Name:P
Last Name:BURLAS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 WILLIAMS RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9317
Mailing Address - Country:US
Mailing Address - Phone:330-449-3300
Mailing Address - Fax:330-449-3301
Practice Address - Street 1:1026 WILLIAMS RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9317
Practice Address - Country:US
Practice Address - Phone:330-449-3300
Practice Address - Fax:330-449-3301
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3R.002863207L00000X
PAOS012971207L00000X
RIDO00840207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079460QH0Medicare ID - Type Unspecified