Provider Demographics
NPI:1598725780
Name:BURDEN, MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BURDEN
Suffix:
Gender:F
Credentials:DO
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 7203
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7303
Mailing Address - Country:US
Mailing Address - Phone:317-682-2038
Mailing Address - Fax:
Practice Address - Street 1:3850 SHORE DR STE 315
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4693
Practice Address - Country:US
Practice Address - Phone:317-682-2038
Practice Address - Fax:317-920-7482
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002905A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200540580AMedicaid
INI41176Medicare UPIN
IN200540580AMedicaid