Individual
DR. CHARLES ERNEST BURT
Active
Individual
DR. CHARLES ERNEST BURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001508
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031200
VALUE OPTIONS PROVIDER ID
VA
01
—
107617
ANTHEM BXBS RESTON ADDR
VA
01
—
54-1848078
FEDERAL EMPLOYER ID #
—
Enumeration date
01/17/2007
Last updated
02/29/2020
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