Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101236442 | VA |
NPI | 1164467601 |
---|---|
Provider Name | Dr. Burton M Sundin |
First Address | Richmond, VA 23229-4920 |
Second Address | Richmond, VA 23229-4920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164467601 | (05) | VA |
H91165 | (02) | VA |