Healthcare Provider Details

I. General information

NPI: 1144704982
Provider Name (Legal Business Name): EMILY D BURNWORTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-5304
US

IV. Provider business mailing address

2894 BURGUNDY PL
WOODBRIDGE VA
22192-1943
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-8891
  • Fax: 833-941-2357
Mailing address:
  • Phone: 570-660-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC06959
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: