Provider Demographics
NPI:1104837442
Name:BURRELL, LINDA M (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BURRELL
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 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:400
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-942-9220
Mailing Address - Fax:301-942-9220
Practice Address - Street 1:2730 UNIVERSITY BLVD W
Practice Address - Street 2:400
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1905
Practice Address - Country:US
Practice Address - Phone:301-942-9220
Practice Address - Fax:301-942-9220
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035996174400000X
DCMD21323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD358761400Medicaid
00A180O85Medicare ID - Type Unspecified
MD358761400Medicaid