Provider Demographics
NPI:1578540662
Name:BURTON, SAMIA (MD)
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMIA
Other - Middle Name:E
Other - Last Name:MERCHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7021010OtherAETNA PIN #
INQ0417069OtherSHO
IN000000081502OtherANTHEM
IN000000547923OtherANTHEM PIN #
IN200199960Medicaid
IN200311740FOtherMEDICAID GROUP #
G99959Medicare UPIN
IN000000547923OtherANTHEM PIN #
INQ0417069OtherSHO