Healthcare Provider Details

I. General information

NPI: 1629172143
Provider Name (Legal Business Name): RACHEL G BURGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 POT SPRING RD HEALTH OFFICE
TIMONIUM MD
21093-2732
US

IV. Provider business mailing address

2600 POT SPRING RD HEALTH OFFICE
TIMONIUM MD
21093-2732
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-4000
  • Fax: 410-252-0869
Mailing address:
  • Phone: 410-252-4000
  • Fax: 410-252-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0058921
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: