MEDICARE: MATTHEW J BURNETT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	009606	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467457440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J BURNETT PA

Provider Business Mailing Address
First Line	:	6620 FLY ROAD
Second Line	:	STE 200
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057
Country	:	US
Telephone Number	:	315-464-4472
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 FLY ROAD
Second Line	:	STE 200
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057
Country	:	US
Telephone Number	:	315-464-4472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/30/2009

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