Provider Demographics
NPI:1487806006
Name:BURNS, ANDREW MARTIN (PA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MARTIN
Last Name:BURNS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10485 N PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1097
Mailing Address - Country:US
Mailing Address - Phone:317-848-2427
Mailing Address - Fax:317-848-2434
Practice Address - Street 1:10485 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1097
Practice Address - Country:US
Practice Address - Phone:317-848-2427
Practice Address - Fax:317-848-2434
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104831363AM0700X
IN1000105A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10001050AOtherINDIANA LICENSE