Provider Demographics
NPI:1336148154
Name:MASHBURN, BURT M (MD)
Entity Type:Individual
Prefix:MR
First Name:BURT
Middle Name:M
Last Name:MASHBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:STE 202
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-489-1038
Mailing Address - Fax:860-496-4094
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:STE 202
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-1038
Practice Address - Fax:860-496-4094
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030862207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58049Medicare UPIN