Healthcare Provider Details

I. General information

NPI: 1033640842
Provider Name (Legal Business Name): CAITLIN MARIE BURK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CAMBRIDGE ST STE 530
BOSTON MA
02114-3108
US

IV. Provider business mailing address

2 HAWTHORNE PL APT 6F
BOSTON MA
02114-2307
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number282926
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number282926
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: