Basic Information
| Provider Information | |||||||||
| NPI: | 1588898712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 N WOLFE ST | ||||||||
| Address2: | WB602 - GPMR OFFICE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212052103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109553362 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 615 N WOLFE ST | ||||||||
| Address2: | WB602 - GPMR OFFICE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212052103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109553362 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2009 | ||||||||
| LastUpdateDate: | 09/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 45779 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D77769 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.