1487652269 NPI number — MR. CHRISTOPHER J BURROUGHS PA

Table of content: MR. CHRISTOPHER J BURROUGHS PA (NPI 1487652269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487652269 NPI number — MR. CHRISTOPHER J BURROUGHS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURROUGHS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487652269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64531
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-280-6568
Provider Business Mailing Address Fax Number:
410-280-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-266-2720
Provider Business Practice Location Address Fax Number:
410-280-6515
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C0002485 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7927475 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3126475 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 487760200 . This is a "FEDERAL WORKMANS COMP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com