Provider Demographics
NPI:1881852325
Name:BURSTYN, TODD LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:LOUIS
Last Name:BURSTYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 CROSSROADS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5441
Mailing Address - Country:US
Mailing Address - Phone:410-998-9100
Mailing Address - Fax:410-998-9104
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-998-9100
Practice Address - Fax:410-998-9104
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD72864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine