MEDICARE: DR. CAROLYN SULLIVAN BURKLOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	D40265	MD
2	2080P0206X	Pediatric Gastroenterology Physician	D40265	MD

General Provider Information

NPI Number	:	1093770356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN SULLIVAN BURKLOW M.D.

Provider Business Mailing Address
First Line	:	9904 WILLOW TREE TER
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-5473
Country	:	US
Telephone Number	:	301-251-6179
Fax Number	:

Provider Business Practice Location Address
First Line	:	4954 N PALMER RD
Second Line	:	DEPARTMENT OF PEDIATRICS, WRNMMC
City	:	BETHESDA
State	:	MD
Zip	:	20889-5630
Country	:	US
Telephone Number	:	301-319-2825
Fax Number	:	301-295-5069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	05/02/2024

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