Healthcare Provider Details

I. General information

NPI: 1588215875
Provider Name (Legal Business Name): MATHANDRA BURKETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N POINTE BLVD
LANCASTER PA
17601-4132
US

IV. Provider business mailing address

170 N POINTE BLVD
LANCASTER PA
17601-4132
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-4871
  • Fax: 717-391-2494
Mailing address:
  • Phone: 717-299-4871
  • Fax: 717-517-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: