Mary Louise Burbank, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

001431 Issued in CT

Practice address

540 Saybrook Rd Ste 100
Middletown, CT 06457-4760

Phone

(860) 287-1078

NPI assigned

Dec 30, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Louise Gates Former name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MHS Primary Care, Inc

  • Family Medicine Physician
  • Middletown, CT
  • NPI 1336279058
  Medicare reassignment NPD
• MHS Primary Care Inc

  • Internal Medicine Physician
  • Essex, CT
  • NPI 1750276655
  NPD
• MHS Primary Care Inc.

  • Surgery Physician
  • Middletown, CT
  • NPI 1740666312

  Dietitian, Registered

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577664000000",
    "number": "1922647601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 RUSSELL ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 SAYBROOK RD STE 100",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574760",
            "telephone_number": "860-287-1078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURBANK",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-30",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "001431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "GATES",
            "middle_name": "LOUISE",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shirley Brunot, MSN FNP-BC
• Daniel J Bryant, MSED, LPC
• Alec William Buchanan, PHD MD
• Building Connections Counseling & Wellness Group, LLC.
• Theresa Burak
• Shelley Burchsted, MD
• Burgess Health Associates, LLC
• Burgess Health Associates, LLC
• Darlene Marie Burlock, RN
• Craig Gazland Burns, MD

• Registered Dietitian in Middletown, CT
• Providers in Middletown, CT by specialty
• Registered Dietitian in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.