Healthcare Provider Details

I. General information

NPI: 1730295023
Provider Name (Legal Business Name): MARK A BURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 COMMON OAKS DR SUITE 100
RALEIGH NC
27614-7298
US

IV. Provider business mailing address

120 WILLIAM PENN PLZ
DURHAM NC
27704-2150
US

V. Phone/Fax

Practice location:
  • Phone: 919-453-5740
  • Fax: 919-453-5741
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-313-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2000-00371
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2000-00371
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: