Basic Information
| Provider Information | |||||||||
| NPI: | 1598712119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURLEW | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PRENTICE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 5325 NORTHGATE DRIVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106258898 | ||||||||
| FaxNumber: | 6106258899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | MD037049E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 91964 | 01 | PA | UNISON | OTHER | P867065 | 01 | PA | OXFORD | OTHER | 020055700 | 01 | PA | BLACK LUNG | OTHER | BU608961 | 01 | PA | PA BLUE SHIELD | OTHER | 290009012 | 01 | PA | RAILROAD MEDICARE | OTHER | 4273808 | 01 | PA | AETNA | OTHER | 0012094500002 | 05 | PA | MEDICAID | 01182701 | 01 | PA | CAPITAL BLUE CROSS | OTHER |