Provider Demographics
NPI:1457374654
Name:BURLAS, REGIS P (DO)
Entity Type:Individual
Prefix:
First Name:REGIS
Middle Name:P
Last Name:BURLAS
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 1:1131 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3545
Mailing Address - Country:US
Mailing Address - Phone:401-287-4440
Mailing Address - Fax:401-461-4791
Practice Address - Street 1:1131 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3545
Practice Address - Country:US
Practice Address - Phone:401-287-4440
Practice Address - Fax:401-461-4791
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012971207L00000X
RIDO00840207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079460QH0Medicare ID - Type Unspecified