Healthcare Provider Details

I. General information

NPI: 1770577900
Provider Name (Legal Business Name): DANA BURKHOLDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 SHANNONDELL DR
AUDUBON PA
19403
US

IV. Provider business mailing address

PO BOX 789967
PHILADELPHIA PA
19178-9967
US

V. Phone/Fax

Practice location:
  • Phone: 484-392-4045
  • Fax: 484-392-4049
Mailing address:
  • Phone: 484-622-7395
  • Fax: 484-622-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009969L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: