Provider Demographics
NPI:1083497952
Name:BURTON, LENNY RAY (ATP, SMS)
Entity Type:Individual
Prefix:
First Name:LENNY
Middle Name:RAY
Last Name:BURTON
Suffix:
Gender:M
Credentials:ATP, SMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:SHARPTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21861-0064
Mailing Address - Country:US
Mailing Address - Phone:410-430-5160
Mailing Address - Fax:
Practice Address - Street 1:7167 WORCESTER HWY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:MD
Practice Address - Zip Code:21841-2027
Practice Address - Country:US
Practice Address - Phone:410-430-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment