Provider Demographics
NPI:1336133057
Name:BURTON, SONYA KAY (MD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:KAY
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:K
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4920 ELM ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2995
Mailing Address - Country:US
Mailing Address - Phone:240-483-0555
Mailing Address - Fax:
Practice Address - Street 1:4920 ELM ST STE 250
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2995
Practice Address - Country:US
Practice Address - Phone:240-483-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87043207ZD0900X
KY44098207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000713442OtherANTHEM
KYK005520Medicare PIN
KY000000713442OtherANTHEM