Provider Demographics
NPI:1962448845
Name:BURNESS, MARGERIE (MD)
Entity Type:Individual
Prefix:
First Name:MARGERIE
Middle Name:
Last Name:BURNESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 SHADE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2878
Mailing Address - Country:US
Mailing Address - Phone:941-359-8939
Mailing Address - Fax:941-358-3934
Practice Address - Street 1:8451 SHADE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2878
Practice Address - Country:US
Practice Address - Phone:941-359-8939
Practice Address - Fax:941-358-3934
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75203207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43839AMedicare ID - Type Unspecified
FLG78970Medicare UPIN