Individual
SALLY A BURTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
901 NEVIN AVE, RICHMOND, CA 94801-3143
(510) 307-2372
(510) 307-2374
Mailing address
901 NEVIN AVE, RICHMOND, CA 94801-3143
(510) 307-2372
(510) 307-2374
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A94836
CA
207N00000X
Dermatology Physician
MD422621
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2224495000
KEYSTONE HP EAST
PA
01
—
3648861
AETNA
PA
Enumeration date
06/16/2005
Last updated
12/13/2021
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