Provider Demographics
NPI:1780278374
Name:BURNS, MICHAEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FAIRBANKS DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-6356
Mailing Address - Country:US
Mailing Address - Phone:203-512-4669
Mailing Address - Fax:
Practice Address - Street 1:19801 OBSERVATION DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4070
Practice Address - Country:US
Practice Address - Phone:301-557-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110-007750OtherSTATE LICENSE
MDC08518OtherSTATE LICENCE