Provider Demographics
NPI:1265665319
Name:BURR, AMANDA A (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:BURR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-272-1900
Mailing Address - Fax:401-453-3049
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-272-1900
Practice Address - Fax:401-453-3049
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2016-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA3824363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA3824OtherMASSACHUSETTS LIC #