Basic Information
| Provider Information | |||||||||
| NPI: | 1881603819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKITT | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | SAMUEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2075 EAGLE WAY | ||||||||
| Address2: | |||||||||
| City: | HATFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157239281 | ||||||||
| FaxNumber: | 2157237044 | ||||||||
| Practice Location | |||||||||
| Address1: | FORD AND MONUMENT RD | ||||||||
| Address2: | BELMONT COMPREHENSIVE CENTER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158772000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN140614L | PA | X | Nursing Service Providers | Registered Nurse | 367500000X | 197105 | PA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0091823000 | 01 | 10 DIGIT HMOID | OTHER |