Basic Information
| Provider Information | |||||||||
| NPI: | 1699743260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNAUGH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 MAIN ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HILTON HEAD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299261648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436823583 | ||||||||
| FaxNumber: | 8436823597 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 MAIN ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HILTON HEAD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299261648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436823583 | ||||||||
| FaxNumber: | 8436823597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 26860 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 26860 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | CI9902 | 01 | SC | SC RR MCARE GRP # | OTHER | P00142523 | 01 | SC | SC RR MEDICARE | OTHER | G44180 | 05 | SC | MEDICAID |