Healthcare Provider Details

I. General information

NPI: 1134163801
Provider Name (Legal Business Name): MARK E BURTON, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 FLORAL VALE BLVD
YARDLEY PA
19067-5528
US

IV. Provider business mailing address

PO BOX 568
BRISTOL PA
19007-0568
US

V. Phone/Fax

Practice location:
  • Phone: 215-504-9266
  • Fax: 215-504-8373
Mailing address:
  • Phone: 215-504-9266
  • Fax: 215-504-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierCD9029
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTRAVELERS MEDICARE
# 2
Identifier669858
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name: MARK E BURTON
Title or Position: PRESIDENT
Credential: DPM
Phone: 215-504-9266