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General NPI Number Information
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NPI Number | 1982900221
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Entity Type | Organization
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Legal Business Name | GARY BURTON, M.D., LLC
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 4000 MITCHELLVILLE RD SUITE 306
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City | BOWIE
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State | MD
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Zip | 20716-3104
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Country | US
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Telephone | 301-441-3375
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Fax | 301-441-4711
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Provider Business Mailing Address
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Address Line | 4000 MITCHELLVILLE RD SUITE 306
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City | BOWIE
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State | MD
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Zip | 20716-3104
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Country | US
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Telephone | 301-441-3375
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Fax | 301-441-4711
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. JOYCE MARIALICE BURTON
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Credential | PH.D.
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Telephone | 301-441-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | D0052974
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License Number State | MD
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