Provider Demographics
NPI:1972692515
Name:BURNETT, CHRISTINA MAUREEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MAUREEN
Last Name:BURNETT
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 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0034
Mailing Address - Fax:716-323-0292
Practice Address - Street 1:818 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1021
Practice Address - Country:US
Practice Address - Phone:716-323-2000
Practice Address - Fax:716-323-0292
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212862-1208000000X
NY212862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1211504OtherIHA
000526982002OtherBC/BS
080130000088OtherFIDELIS
00026226801OtherUNIVERA
NY02330069Medicaid
PA0019172900001Medicaid
040426003003OtherFIDELIS
000526982001OtherBC/BS
000526982001OtherBC/BS
NY02330069Medicaid