Provider Demographics
NPI:1174048045
Name:BURTON, JASON A
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:BURTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 IDLEWILD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3883
Mailing Address - Country:US
Mailing Address - Phone:410-820-8226
Mailing Address - Fax:
Practice Address - Street 1:510 IDLEWILD AVE STE 200
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3883
Practice Address - Country:US
Practice Address - Phone:410-820-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1145067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant