Basic Information
| Provider Information | |||||||||
| NPI: | 1386650927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKHART-EDELEN | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 MOTOR PKWY STE 309 | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117885124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315147600 | ||||||||
| FaxNumber: | 6318131472 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708277700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01069980A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.085187 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 40034 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01069980A | 01 | IN | STATE MEDICAL LICENSE | OTHER |