Healthcare Provider Details

I. General information

NPI: 1598725780
Provider Name (Legal Business Name): MARY BURDEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SHORE DR STE 315
INDIANAPOLIS IN
46254-4693
US

IV. Provider business mailing address

PO BOX 7203
FISHERS IN
46038-7303
US

V. Phone/Fax

Practice location:
  • Phone: 317-682-2038
  • Fax: 317-920-7482
Mailing address:
  • Phone: 317-682-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number02002905A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: