Healthcare Provider Details

I. General information

NPI: 1174048045
Provider Name (Legal Business Name): JASON A BURTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 IDLEWILD AVE STE 200
EASTON MD
21601-3883
US

IV. Provider business mailing address

510 IDLEWILD AVE STE 200
EASTON MD
21601-3883
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-8226
  • Fax:
Mailing address:
  • Phone: 410-820-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1145067
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: