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Contact Information

RUSSELL A BURNHAM, PA-C
P-10506 EUPHRATES RIVER VALLEY RD
1-89 CAV, 2BCT, 10TH MTN DIV
FORT DRUM, NY13602-5438
 Phone: 315-774-0024
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for RUSSELL A BURNHAM · (Male)

NPI Number 1700179199
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 05/18/2011
Last updated 08/30/2012 - About 4 years ago
Sole proprietor 1 No
Identifiers n/a
Hospital affiliation(s) n/a
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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