Basic Information
| Provider Information | |||||||||
| NPI: | 1225022858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | NICHOLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S WASHINGTON AVE STE 1000 | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185053814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709410630 | ||||||||
| FaxNumber: | 5702300013 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S WASHINGTON AVE STE 1000 | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185053814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709410630 | ||||||||
| FaxNumber: | 5702300013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD019709E | PA | N | Other Service Providers | Specialist | 2084A0401X | MD019709E | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0007978940002 | 05 | PA | MEDICAID | 0900660001 | 01 | PA | MEDICARE DME | OTHER | 11762 6365 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 072965 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 34369 | 01 | PA | BLUE SHIELD | OTHER | 01042601 | 01 | DC | CAPITAL BLUE CROSS | OTHER | 20010385 | 01 | PA | AMERIHEALTH MERCY | OTHER | 000000075845 | 01 | PA | MEDPLUS | OTHER | 2Y1004 | 01 | PA | HEALTHNET | OTHER | 340009441 | 01 | PA | TRAVELER'S RAILROAD MEDIC | OTHER | 505911 | 01 | PA | AETNA US HEALTHCARE | OTHER |