Provider Demographics
NPI:1144350935
Name:CHARLES V BURTON MD PA
Entity type:Organization
Organization Name:CHARLES V BURTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-287-8781
Mailing Address - Street 1:514 SAINT PETER ST
Mailing Address - Street 2:STE 220
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1001
Mailing Address - Country:US
Mailing Address - Phone:651-287-8781
Mailing Address - Fax:651-287-8782
Practice Address - Street 1:514 SAINT PETER ST
Practice Address - Street 2:STE 220
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1001
Practice Address - Country:US
Practice Address - Phone:651-287-8781
Practice Address - Fax:651-287-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND03091305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94327Medicare UPIN
C03588Medicare PIN