Basic Information
| Provider Information | |||||||||
| NPI: | 1922081769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | WOODROW | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1851 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043849679 | ||||||||
| FaxNumber: | 7043160508 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 BEN FRANKLIN BLVD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194794400 | ||||||||
| FaxNumber: | 9194794415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 01/23/2008 | ||||||||
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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 | 208600000X | 17677 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1560937001 | 01 | NC | CIGNA HEALTHCARE OF NC | OTHER | 8920211 | 05 | NC | MEDICAID | 20211 | 01 | NC | BCBSNC | OTHER |