Provider Demographics
NPI:1699743260
Name:BURNAUGH, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BURNAUGH
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 1:23 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1648
Mailing Address - Country:US
Mailing Address - Phone:843-682-3583
Mailing Address - Fax:843-682-3597
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1648
Practice Address - Country:US
Practice Address - Phone:843-682-3583
Practice Address - Fax:843-682-3597
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26860207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCI9902OtherSC RR MCARE GRP #
SCP00142523OtherSC RR MEDICARE
SCG44180Medicaid
SCCI9902OtherSC RR MCARE GRP #
SCG44180Medicaid