Provider Demographics
NPI:1487652269
Name:BURROUGHS, CHRISTOPHER J (PA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:PA
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 64531
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4531
Mailing Address - Country:US
Mailing Address - Phone:410-280-6568
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2720
Practice Address - Fax:410-280-6515
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
7927475OtherAETNA
3126475OtherAETNA HMO
487760200OtherFEDERAL WORKMANS COMP
3126475OtherAETNA HMO
MDP88732Medicare UPIN
487760200OtherFEDERAL WORKMANS COMP
P00332523Medicare PIN