Provider Demographics
NPI:1548557630
Name:BURNS, AMANDA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:BURNS
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 1:2200 JOHN R WOODEN DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1863
Mailing Address - Country:US
Mailing Address - Phone:317-988-0112
Mailing Address - Fax:317-988-5512
Practice Address - Street 1:2200 JOHN R WOODEN DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1863
Practice Address - Country:US
Practice Address - Phone:317-988-0112
Practice Address - Fax:317-988-5512
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074343A207R00000X
MO2011019840390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program