Healthcare Provider Details

I. General information

NPI: 1558416552
Provider Name (Legal Business Name): THOMAS EMMETT BURNS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

10030 WINDY HOLLOW RD
GREAT FALLS VA
22066-3547
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3000
  • Fax:
Mailing address:
  • Phone: 703-759-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101055259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: