Healthcare Provider Details

I. General information

NPI: 1225000623
Provider Name (Legal Business Name): ERIC JASON BURKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 ALBANY STREET SUITE 304
BOSTON MA
02118-2646
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5314
  • Fax: 617-414-5315
Mailing address:
  • Phone: 617-414-5405
  • Fax: 617-414-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number223504
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number223504
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: