Healthcare Provider Details

I. General information

NPI: 1619035524
Provider Name (Legal Business Name): WILLIAM LEROY BURNER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 NORTH CAPITOL STREET NE
WASHINGTON DC
20002-4236
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMP. UNIT 6 KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 202-898-5104
  • Fax: 202-898-5474
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101019813
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD54601
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD31536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: