Provider Demographics
NPI:1790974152
Name:BURSTEIN, DARA E (CRNP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:E
Last Name:BURSTEIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 CENTRE PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2382
Mailing Address - Country:US
Mailing Address - Phone:410-730-1000
Mailing Address - Fax:410-730-2266
Practice Address - Street 1:8875 CENTRE PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2382
Practice Address - Country:US
Practice Address - Phone:410-730-1000
Practice Address - Fax:410-730-2266
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168613363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC4280004OtherBLUE SHIELD
MD92501601OtherBLUE SHIELD
130249Medicare PIN
136869YLZMedicare PIN