Provider Demographics
NPI:1831347285
Name:BURLESON, ANDREW LEE (ARRT(R)(CT))
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:BURLESON
Suffix:
Gender:M
Credentials:ARRT(R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-9598
Mailing Address - Country:US
Mailing Address - Phone:304-252-4785
Mailing Address - Fax:
Practice Address - Street 1:407 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827-9598
Practice Address - Country:US
Practice Address - Phone:304-252-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32812471C3401X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3281OtherSTATE OF WEST VIRGINIA MEDICAL IMAGING AND RADIATION THERAPY