MEDICARE: MADELINE BURSON MDN, RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD.11487	OH

General Provider Information

NPI Number	:	1366390106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE BURSON MDN, RDN, LD

Provider Business Mailing Address
First Line	:	2555 S DIXIE DR STE 112
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-1532
Country	:	US
Telephone Number	:	937-220-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 S DIXIE DR STE 112
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-1532
Country	:	US
Telephone Number	:	937-220-6611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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