Provider Demographics
NPI:1083372718
Name:BURRIS, DESMOND
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:BURRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 CAPITAL LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1061
Mailing Address - Country:US
Mailing Address - Phone:202-255-8281
Mailing Address - Fax:
Practice Address - Street 1:200 K ST NE APT 838
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3086
Practice Address - Country:US
Practice Address - Phone:202-255-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide