1093895518 NPI number — MRS. ANGIE MARIE BURT N.P.

Table of content: MRS. ANGIE MARIE BURT N.P. (NPI 1093895518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093895518 NPI number — MRS. ANGIE MARIE BURT N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURT
Provider First Name:
ANGIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAGE
Provider Other First Name:
ANGIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093895518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 SKYLINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-848-6654
Provider Business Mailing Address Fax Number:
703-858-3529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 CENTER STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-288-2222
Provider Business Practice Location Address Fax Number:
703-858-3529
Provider Enumeration Date:
10/17/2006

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: 363LF0000X , with the licence number:  0024165010 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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