Healthcare Provider Details

I. General information

NPI: 1699749309
Provider Name (Legal Business Name): JEFFREY B BURL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PLANTATION ST
WORCESTER MA
01605
US

IV. Provider business mailing address

630 PLANTATION ST WOT 12TH FLOOR ATTN. PHYSICIAN SERVICES
WORCESTER MA
01605
US

V. Phone/Fax

Practice location:
  • Phone: 508-595-2000
  • Fax: 508-853-7149
Mailing address:
  • Phone: 508-595-2000
  • Fax: 508-853-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number43815
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9900150
Identifier TypeOTHER
Identifier State
Identifier IssuerFALLON COMMUNITY HLTH PLN
# 2
IdentifierE38004
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE B
# 3
Identifier0400884
Identifier TypeOTHER
Identifier State
Identifier IssuerEVERCARE
# 4
Identifier4580406
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA US HEALTHCARE
# 5
Identifier2097559
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 6
Identifier5952616
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA HEALTH PLAN
# 7
IdentifierAA2837
Identifier TypeOTHER
Identifier State
Identifier IssuerHARVARD PILGRIM HEALTHCRE
# 8
Identifier2097559
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICAID WELFARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: