Healthcare Provider Details

I. General information

NPI: 1811199474
Provider Name (Legal Business Name): RICHARD J. BURNS, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 SPRUCE ST SUITE 609
SCRANTON PA
18503-1400
US

IV. Provider business mailing address

321 SPRUCE ST SUITE 609
SCRANTON PA
18503-1400
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-3700
  • Fax: 570-343-6088
Mailing address:
  • Phone: 570-961-3700
  • Fax: 570-343-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS-008562-L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0017112680006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. RICHARD JOHN BURNS
Title or Position: PRESIDENT
Credential: D.O
Phone: 570-961-3700