MEDICARE: DR. GEORGE J BURNETT M.D.

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	2084P0800X	Psychiatry Physician	211844-1	NY

General Provider Information

NPI Number	:	1225056203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE J BURNETT M.D.

Provider Business Mailing Address
First Line	:	21 SUMMIT AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-2305
Country	:	US
Telephone Number	:	716-838-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FOREST AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14213-1207
Country	:	US
Telephone Number	:	716-816-2086
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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