Provider Demographics
NPI:1659420404
Name:BURNS, JARRETT M (DO)
Entity Type:Individual
Prefix:
First Name:JARRETT
Middle Name:M
Last Name:BURNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0322
Mailing Address - Country:US
Mailing Address - Phone:949-552-4584
Mailing Address - Fax:949-551-5612
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3599
Practice Address - Country:US
Practice Address - Phone:603-669-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18409207P00000X, 207PT0002X
MA236596207PT0002X, 207P00000X
CA20A18898207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110081828AMedicaid
MA001165201Medicare PIN
MA2176262Medicaid