MEDICARE: DR. DAVID RUSSELL BURNS 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	MD009387E	PA

General Provider Information

NPI Number	:	1952349060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RUSSELL BURNS M.D.

Provider Business Mailing Address
First Line	:	1704 GREEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3912
Country	:	US
Telephone Number	:	215-837-4000
Fax Number	:	267-324-5983

Provider Business Practice Location Address
First Line	:	1704 GREEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3912
Country	:	US
Telephone Number	:	215-837-4000
Fax Number	:	267-324-5983

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/09/2022

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