Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 01072756A | IN |
N | 207ND0900X | Dermatopathologist | 01072756A | IN |
NPI | 1205028164 |
---|---|
Provider Name | Dr. Laura Mathis Burdick |
First Address | Columbus, IN 47201-2960 |
Second Address | Columbus, IN 47201-2960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 30/06/2020 |