Healthcare Provider Details

I. General information

NPI: 1871646919
Provider Name (Legal Business Name): BURKE DERMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD STE 107
NEWARK DE
19713-4248
US

IV. Provider business mailing address

774 CHRISTIANA RD STE 107
NEWARK DE
19713-4248
US

V. Phone/Fax

Practice location:
  • Phone: 302-230-3376
  • Fax: 302-224-4990
Mailing address:
  • Phone: 302-230-3376
  • Fax: 302-224-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC20006239
License Number StateDE

VIII. Authorized Official

Name: THOMAS JOHN BURKE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 302-230-3376