Healthcare Provider Details

I. General information

NPI: 1982900221
Provider Name (Legal Business Name): GARY BURTON, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MITCHELLVILLE RD SUITE 306
BOWIE MD
20716-3104
US

IV. Provider business mailing address

4000 MITCHELLVILLE RD SUITE 306
BOWIE MD
20716-3104
US

V. Phone/Fax

Practice location:
  • Phone: 301-441-3375
  • Fax: 301-441-4711
Mailing address:
  • Phone: 301-441-3375
  • Fax: 301-441-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberD0052974
License Number StateMD

VIII. Authorized Official

Name: DR. JOYCE MARIALICE BURTON
Title or Position: CHIEF OPERATING OFFICER
Credential: PH.D.
Phone: 301-441-3375