MEDICARE: DR. MELISSA MARIE BURMAN MD

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	207RS0010X	Sports Medicine (Internal Medicine) Physician	A174167	CA

General Provider Information

NPI Number	:	1881198166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA MARIE BURMAN MD

Provider Business Mailing Address
First Line	:	924 TIDE CT
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1145
Country	:	US
Telephone Number	:	650-564-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 SORRENTO VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1618
Country	:	US
Telephone Number	:	858-793-7860
Fax Number	:	619-814-5414

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

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	06/27/2024

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