Healthcare Provider Details

I. General information

NPI: 1740327162
Provider Name (Legal Business Name): CYNTHIA M BURNHAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
SACO ME
04072-1543
US

IV. Provider business mailing address

180 US ROUTE ONE #1
SCARBOROUGH ME
04074
US

V. Phone/Fax

Practice location:
  • Phone: 207-602-3571
  • Fax: 207-602-3573
Mailing address:
  • Phone: 207-289-3640
  • Fax: 207-883-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1180
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: