Provider Demographics
NPI:1710965710
Name:BURBANO, JESUS A (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:A
Last Name:BURBANO
Suffix:
Gender:M
Credentials:MD
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 13037
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20911-0037
Mailing Address - Country:US
Mailing Address - Phone:301-585-1230
Mailing Address - Fax:301-585-2446
Practice Address - Street 1:8615 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3408
Practice Address - Country:US
Practice Address - Phone:301-585-1230
Practice Address - Fax:301-585-2446
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4050771 00Medicaid