MEDICARE: PATRICIA BURKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	210394	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235287749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BURKE MD

Provider Business Mailing Address
First Line	:	128 S BROAD ST
Second Line	:
City	:	NORWICH
State	:	NY
Zip	:	13815-1748
Country	:	US
Telephone Number	:	607-336-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 EATON AVE
Second Line	:
City	:	NORWICH
State	:	NY
Zip	:	13815-1768
Country	:	US
Telephone Number	:	607-334-9780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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