Healthcare Provider Details

I. General information

NPI: 1467657106
Provider Name (Legal Business Name): SONYA MAKEBA BURROUGHS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVE
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

641 SLIGO AVE APT. 105
SILVER SPRING MD
20910-4767
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 301-589-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035504
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: