Healthcare Provider Details

I. General information

NPI: 1548869753
Provider Name (Legal Business Name): REBECCA MICHELLE BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W LEXINGTON ST STE 5110
BALTIMORE MD
21201-1508
US

IV. Provider business mailing address

620 W LEXINGTON ST STE 5110
BALTIMORE MD
21201-1508
US

V. Phone/Fax

Practice location:
  • Phone: 443-966-5127
  • Fax:
Mailing address:
  • Phone: 443-966-5127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008126
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: