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General NPI Number Information
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NPI Number | 1548557630
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Entity Type | Individual
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Provider Name | AMANDA MARIE BURNS M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 2200 JOHN R WOODEN DR
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1863
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Country | US
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Telephone | 317-988-0112
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Fax | 317-988-5512
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Provider Business Mailing Address
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Address Line | 2200 JOHN R WOODEN DR
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1863
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Country | US
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Telephone | 317-988-0112
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Fax | 317-988-5512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01074343A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2011019840
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License Number State | MO
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