MEDICARE: JAMES RANDALL BURNETT MD

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	2084P0800X	Psychiatry Physician	014300	ME

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	:	1801808647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RANDALL BURNETT MD

Provider Business Mailing Address
First Line	:	169 PARK ROW STE 11
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2039
Country	:	US
Telephone Number	:	207-522-4376
Fax Number	:	207-725-2473

Provider Business Practice Location Address
First Line	:	169 PARK ROW STE 11
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2039
Country	:	US
Telephone Number	:	207-522-4376
Fax Number	:	207-725-2473

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	03/30/2017

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