Basic Information
Provider Information
NPI: 1184940801
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURBANK
FirstName: ALLISON
MiddleName: JANE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 PERIMETER PARK DR STE 200
Address2:  
City: MORRISVILLE
State: NC
PostalCode: 275608442
CountryCode: US
TelephoneNumber: 9842154110
FaxNumber:  
Practice Location
Address1: 1301 CENTRAL DR
Address2:  
City: SANFORD
State: NC
PostalCode: 273304159
CountryCode: US
TelephoneNumber: 9197189512
FaxNumber: 9197189516
Other Information
ProviderEnumerationDate: 04/20/2010
LastUpdateDate: 05/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0201X2014-00830NCY Allopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology

No ID Information.


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