Provider Demographics
NPI:1619035524
Name:BURNER, WILLIAM LEROY III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEROY
Last Name:BURNER
Suffix:III
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET PPQA MEDICARE COMP. UNIT 6
Mailing Address - Street 2:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:1011 NORTH CAPITOL STREET NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4236
Practice Address - Country:US
Practice Address - Phone:202-898-5104
Practice Address - Fax:202-898-5474
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101019813207X00000X
MDD54601207X00000X
WAMD31536207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48799Medicare UPIN
003076M92Medicare ID - Type Unspecified