Provider Demographics
NPI:1992890222
Name:BURT, ANGELA M (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:BURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BARONNE ST APT 1211
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1750
Mailing Address - Country:US
Mailing Address - Phone:707-755-1148
Mailing Address - Fax:
Practice Address - Street 1:3947 LENNANE DR STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1971
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV116792084P0800X
CAA938972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1423921Medicaid
LA1423921Medicaid
LA4E381Medicare ID - Type Unspecified