Healthcare Provider Details

I. General information

NPI: 1265509228
Provider Name (Legal Business Name): JANICE TILDON BURTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE SUITE 207
NEWARK DE
19702-4773
US

IV. Provider business mailing address

2600 GLASGOW AVE SUITE 207
NEWARK DE
19702-4773
US

V. Phone/Fax

Practice location:
  • Phone: 302-832-1124
  • Fax: 302-832-1129
Mailing address:
  • Phone: 302-832-1124
  • Fax: 302-832-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0003572
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: