MEDICARE: BRIAN ALAN BURNE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-02171	NC

General Provider Information

NPI Number	:	1114257284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ALAN BURNE PA-C

Provider Business Mailing Address
First Line	:	5838 SIX FORKS RD
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27609-3885
Country	:	US
Telephone Number	:	919-785-3400
Fax Number	:	919-783-7810

Provider Business Practice Location Address
First Line	:	5838 SIX FORKS RD
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27609-3885
Country	:	US
Telephone Number	:	919-785-3400
Fax Number	:	919-783-7810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	10/25/2010

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