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NPI Code Detail

MEDICARE: SALLY A BURTLE M.D.

MEDICARE: SALLY A BURTLE 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
1207N00000XDermatology PhysicianMD422621PA
2207N00000XDermatology PhysicianA94836CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13648861OTHERPAAETNA
22224495000OTHERPAKEYSTONE HP EAST

General Provider Information

NPI Number : 1821093972
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY A BURTLE M.D.
Provider Business Mailing Address
First Line : 901 NEVIN AVE
Second Line :
City : RICHMOND
State : CA
Zip : 94801-3143
Country : US
Telephone Number : 510-307-2372
Fax Number : 510-307-2374
Provider Business Practice Location Address
First Line : 901 NEVIN AVE
Second Line :
City : RICHMOND
State : CA
Zip : 94801-3143
Country : US
Telephone Number : 510-307-2372
Fax Number : 510-307-2374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 12/13/2021

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Directions to “ SALLY A BURTLE M.D.” Practice Location

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