Provider Demographics
NPI:1235568817
Name:BURGESS, LANCE (PA-C)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7920 MCDONOGH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5273
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:866-902-5997
Practice Address - Street 1:8100 SANDPIPER CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4991
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:866-442-5401
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant