Provider Demographics
NPI:1134853229
Name:BURNER, SANTINA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:SANTINA
Middle Name:MARIE
Last Name:BURNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANTINA
Other - Middle Name:
Other - Last Name:POSSANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 HARRY S TRUMAN DR APT 33
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2051
Mailing Address - Country:US
Mailing Address - Phone:570-338-5770
Mailing Address - Fax:
Practice Address - Street 1:3080 WALDORF MARKET PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4872
Practice Address - Country:US
Practice Address - Phone:301-843-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDTA2868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program