Provider Demographics
NPI:1992844294
Name:BURRIS, BOYD LEE (MD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:LEE
Last Name:BURRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 42ND ST NW
Mailing Address - Street 2:SUITE #310
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4623
Mailing Address - Country:US
Mailing Address - Phone:202-244-5500
Mailing Address - Fax:301-656-2564
Practice Address - Street 1:4545 42ND ST NW
Practice Address - Street 2:SUITE #310
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:202-244-5500
Practice Address - Fax:301-656-2564
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD251322084P0800X
MDD00027622084P0800X
VA01010146512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B94241Medicare UPIN
178370Medicare ID - Type Unspecified