MEDICARE: DARA E BURSTEIN CRNP

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	363LA2200X	Adult Health Nurse Practitioner	R168613	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C4280004	OTHER	DC	BLUE SHIELD
2	92501601	OTHER	MD	BLUE SHIELD

General Provider Information

NPI Number	:	1790974152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARA E BURSTEIN CRNP

Provider Business Mailing Address
First Line	:	8875 CENTRE PARK DR
Second Line	:	SUITE D
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-730-1000
Fax Number	:	410-730-2266

Provider Business Practice Location Address
First Line	:	8875 CENTRE PARK DR
Second Line	:	SUITE D
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-730-1000
Fax Number	:	410-730-2266

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	12/01/2008

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