Provider Demographics
NPI:1770571705
Name:BURLINGAME, TODD ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ANTHONY
Last Name:BURLINGAME
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 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8007
Mailing Address - Country:US
Mailing Address - Phone:215-938-3413
Mailing Address - Fax:215-938-3422
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-3413
Practice Address - Fax:215-938-3422
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012978207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010580160001Medicaid
PA081145FWJMedicare PIN