MEDICARE: DR. MARY BURDEN D.O.

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	207RN0300X	Nephrology Physician	02002905A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598725780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BURDEN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 7203
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-7303
Country	:	US
Telephone Number	:	317-682-2038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 SHORE DR STE 315
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4693
Country	:	US
Telephone Number	:	317-682-2038
Fax Number	:	317-920-7482

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	12/20/2022

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