Provider Demographics
NPI:1922081769
Name:BURNS, WALTER WOODROW JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:WOODROW
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1851 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3205
Mailing Address - Country:US
Mailing Address - Phone:704-384-9679
Mailing Address - Fax:704-316-0508
Practice Address - Street 1:4301 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-479-4400
Practice Address - Fax:919-479-4415
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC17677208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1560937001OtherCIGNA HEALTHCARE OF NC
NC8920211Medicaid
NC20211OtherBCBSNC
NC1560937001OtherCIGNA HEALTHCARE OF NC
C85291Medicare UPIN
NC201642DMedicare PIN