Provider Demographics
NPI:1588627582
Name:BURROUGHS, PAUL L (MD PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:P
Other - Middle Name:L
Other - Last Name:BURROUGHS III
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:3801 WAKE FOREST RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6864
Mailing Address - Country:US
Mailing Address - Phone:919-872-5296
Mailing Address - Fax:919-850-9718
Practice Address - Street 1:3801 WAKE FOREST RD STE 220
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6864
Practice Address - Country:US
Practice Address - Phone:919-872-5296
Practice Address - Fax:919-850-9718
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81464207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2272849AOtherMEDICARE PTAN
NC1304920001Medicare NSC
NC2272849AMedicare PIN
NC2272849AOtherMEDICARE PTAN