Provider Demographics
NPI:1912008194
Name:BURTON, MARY CAROLINE (MD,)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROLINE
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:CAROLINE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-1865
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114293207R00000X
MN32533207R00000X, 208M00000X
LA019998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007149100Medicaid
MNP00746330OtherRAILROAD MEDICARE
LA1924938Medicaid
MN135410100Medicaid
LA1924938Medicaid
LA5N788CB12Medicare ID - Type Unspecified
F07573Medicare UPIN
MN135410100Medicaid