Provider Demographics
NPI:1023646825
Name:BURRISS-WEST, MARYBETH ARCEO
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:ARCEO
Last Name:BURRISS-WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:ARCEO
Other - Last Name:BURRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4008 LILA BLUE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6955
Mailing Address - Country:US
Mailing Address - Phone:919-274-0821
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-381-6800
Practice Address - Fax:704-381-6841
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2610272080P0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics