Provider Demographics
NPI:1538777958
Name:BURGOS ROSSY, EDWIN ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:ALEJANDRO
Last Name:BURGOS ROSSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BRIGHTWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5156
Mailing Address - Country:US
Mailing Address - Phone:910-892-1000
Mailing Address - Fax:910-984-3700
Practice Address - Street 1:215 BRIGHTWATER DRIVE
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5156
Practice Address - Country:US
Practice Address - Phone:910-892-1000
Practice Address - Fax:910-984-3700
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program