Provider Demographics
NPI:1770577900
Name:BURKHOLDER, DANA (DO)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BURKHOLDER
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:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:20000 SHANNONDELL DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403
Practice Address - Country:US
Practice Address - Phone:484-392-4045
Practice Address - Fax:484-392-4049
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009969L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017883070004Medicaid
PA034202SBHMedicare PIN
PAH10738Medicare UPIN
PA0017883070004Medicaid