Healthcare Provider Details

I. General information

NPI: 1326039587
Provider Name (Legal Business Name): ALFRED C BURRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 SOUTHERN AVE SE 214
WASHINGTON DC
20032-4689
US

IV. Provider business mailing address

1328 SOUTHERN AVE SE 214
WASHINGTON DC
20032-4689
US

V. Phone/Fax

Practice location:
  • Phone: 202-562-4310
  • Fax: 202-563-3935
Mailing address:
  • Phone: 202-562-4310
  • Fax: 202-563-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0024996
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: