Healthcare Provider Details

I. General information

NPI: 1295880524
Provider Name (Legal Business Name): JAMES BURGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD L1-3
BERWYN HEIGHTS MD
20740-2354
US

IV. Provider business mailing address

6201 GREENBELT RD L1-3
COLLEG PARK MD
20740-2354
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-2270
  • Fax: 301-345-7149
Mailing address:
  • Phone: 301-345-1900
  • Fax: 301-345-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0013962
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: