Provider Demographics
NPI:1073602439
Name:BURROW, MAIDA L (MD)
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:L
Last Name:BURROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 BASELINE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81507-9583
Mailing Address - Country:US
Mailing Address - Phone:970-243-5785
Mailing Address - Fax:970-242-2559
Practice Address - Street 1:2024 BASELINE DR
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81507-9583
Practice Address - Country:US
Practice Address - Phone:970-243-5785
Practice Address - Fax:970-242-2559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO070010873OtherRAILROAD MCR PTAN
29274OtherBCBS
29274OtherBCBS
CO070010873OtherRAILROAD MCR PTAN
COC14861Medicare ID - Type Unspecified