Healthcare Provider Details

I. General information

NPI: 1508605908
Provider Name (Legal Business Name): PATRICK BURNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 PLEASANT ST # 402
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

25 TWIN HILLS DR
LONGMEADOW MA
01106-2949
US

V. Phone/Fax

Practice location:
  • Phone: 508-646-7615
  • Fax:
Mailing address:
  • Phone: 413-386-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA103023
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: