Provider Demographics
NPI:1538228739
Name:BURDEN, PATRICIA ANNE (MD)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:BURDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5782 MAIN STREET,
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8219
Mailing Address - Country:US
Mailing Address - Phone:716-332-1620
Mailing Address - Fax:716-332-1621
Practice Address - Street 1:5782 MAIN STREET,
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8219
Practice Address - Country:US
Practice Address - Phone:716-332-1620
Practice Address - Fax:716-332-1621
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6996207N00000X
NY175248207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030972601Medicaid
TX030972601Medicaid
TX00714GMedicare PIN