Healthcare Provider Details

I. General information

NPI: 1508866658
Provider Name (Legal Business Name): LINDA MARIE BURSTYNOWICZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111B ROBERTS RD
GRINDSTONE PA
15442-1105
US

IV. Provider business mailing address

500 W BERKELEY ST
UNIONTOWN PA
15401-5514
US

V. Phone/Fax

Practice location:
  • Phone: 724-785-2286
  • Fax: 724-785-3187
Mailing address:
  • Phone: 724-430-6555
  • Fax: 724-430-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number071890L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number071890L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0015441410015
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0018184240005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
IdentifierP001930
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY
# 4
Identifier0110237825
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 5
Identifier900236
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 6
Identifier131194
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AMERICA
# 7
Identifier215965
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 8
Identifier112333
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDPLUS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: