Provider Demographics
NPI:1144487653
Name:BURICK, DIANA RENE (PA-C)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RENE
Last Name:BURICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:RENE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1139 BEN FRANKLIN HWY W
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1850
Mailing Address - Country:US
Mailing Address - Phone:610-385-4444
Mailing Address - Fax:
Practice Address - Street 1:1139 BEN FRANKLIN HWY W
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1850
Practice Address - Country:US
Practice Address - Phone:610-385-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053393363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical