Healthcare Provider Details

I. General information

NPI: 1952358459
Provider Name (Legal Business Name): ROGERS C. BURLTON, M.D. CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 LOREE LN
ROCKVILLE MD
20853-2929
US

IV. Provider business mailing address

13800 LOREE LN
ROCKVILLE MD
20853-2929
US

V. Phone/Fax

Practice location:
  • Phone: 301-871-1733
  • Fax: 301-871-9592
Mailing address:
  • Phone: 301-871-1733
  • Fax: 301-871-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberD04506
License Number StateMD

VIII. Authorized Official

Name: DR. ROGERS CHRISTOPHER BURLTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-871-1733