Healthcare Provider Details

I. General information

NPI: 1063453801
Provider Name (Legal Business Name): CAROLYN ADELL BURNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 STONY POINT PKWY
RICHMOND VA
23235-1900
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-8920
  • Fax: 804-998-1255
Mailing address:
  • Phone: 804-922-4844
  • Fax: 804-545-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101043414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: