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General NPI Number Information
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NPI Number | 1225012370
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Entity Type | Individual
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Provider Name | KELLY LYNN BURKERT M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 101 CHESLEY DR
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City | MEDIA
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State | PA
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Zip | 19063-1761
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Country | US
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Telephone | 610-566-7846
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Fax | 610-891-6735
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Provider Business Mailing Address
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Address Line | 101 CHESLEY DR
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City | MEDIA
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State | PA
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Zip | 19063-1761
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Country | US
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Telephone | 610-566-7846
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Fax | 610-891-6735
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME89124
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License Number State | FL
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