Healthcare Provider Details

I. General information

NPI: 1497444863
Provider Name (Legal Business Name): BETHANY BURTON AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9512 HARFORD RD
BALTIMORE MD
21234-3100
US

IV. Provider business mailing address

1901 S CHARLES ST APT 205
BALTIMORE MD
21230-4890
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR228810
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR228810
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: