Healthcare Provider Details

I. General information

NPI: 1730195819
Provider Name (Legal Business Name): ROBERT BURRUS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
WARRENTON VA
20186-3027
US

IV. Provider business mailing address

PO BOX 223323
CHANTILLY VA
20153-3323
US

V. Phone/Fax

Practice location:
  • Phone: 540-349-0595
  • Fax:
Mailing address:
  • Phone: 540-349-0595
  • Fax: 540-349-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110000133
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110000133
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: