Provider Demographics
NPI:1780756429
Name:DIAZ-BURNEY, CARMEN E (MD)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:E
Last Name:DIAZ-BURNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CHEW ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3412
Mailing Address - Country:US
Mailing Address - Phone:484-838-6380
Mailing Address - Fax:484-838-6381
Practice Address - Street 1:1107 EATON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1862
Practice Address - Country:US
Practice Address - Phone:484-526-2400
Practice Address - Fax:484-526-3697
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209355-12084P0800X
PAMD064269L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY453BN1Medicare PIN
NYI19657Medicare UPIN