Provider Demographics
NPI:1548698426
Name:BURTON, BRADLEY (ANP-BC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:ALAN
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:63 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4937
Mailing Address - Country:US
Mailing Address - Phone:703-501-5339
Mailing Address - Fax:
Practice Address - Street 1:50 F ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1530
Practice Address - Country:US
Practice Address - Phone:202-244-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1019273363LA2200X
NJ26NJ00661600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health