1578540662 NPI number — SAMIA BURTON MD

Table of content: SAMIA BURTON MD (NPI 1578540662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578540662 NPI number — SAMIA BURTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
SAMIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERCHO
Provider Other First Name:
SAMIA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578540662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 PENNSYLVANIA AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20037-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 PENNSYLVANIA AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-741-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2005

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: 207R00000X , with the licence number:  01047936 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7021010 . This is a "AETNA PIN #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: Q0417069 . This is a "SHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000081502 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000547923 . This is a "ANTHEM PIN #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200199960 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200311740F . This is a "MEDICAID GROUP #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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