Provider Demographics
NPI:1710951785
Name:BURROUGHS, JOEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 VILLAGE HWY
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-4591
Mailing Address - Country:US
Mailing Address - Phone:434-332-7367
Mailing Address - Fax:434-332-1757
Practice Address - Street 1:925 VILLAGE HWY
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588-4591
Practice Address - Country:US
Practice Address - Phone:434-332-7367
Practice Address - Fax:434-332-1757
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710951785Medicaid
TN1506771Medicaid
TN1506771Medicaid
VA019519R29Medicare PIN