Provider Demographics
NPI:1881756872
Name:BURGESS, CHERYL MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:MARIE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:MARIE
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2311 M ST NW
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1445
Mailing Address - Country:US
Mailing Address - Phone:202-955-5757
Mailing Address - Fax:202-955-5797
Practice Address - Street 1:2311 M STREET, NW
Practice Address - Street 2:SUITE 504
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1495
Practice Address - Country:US
Practice Address - Phone:202-955-5757
Practice Address - Fax:202-955-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15582207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE13427Medicare UPIN
DCG00005Medicare ID - Type UnspecifiedDERMATOLOGY