Healthcare Provider Details

I. General information

NPI: 1255723896
Provider Name (Legal Business Name): JACOB ADAM BURNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

25 E DELAWARE PL APT 1305
CHICAGO IL
60611-1828
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 908-616-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number1019542
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: