Healthcare Provider Details

I. General information

NPI: 1306818422
Provider Name (Legal Business Name): MARY C BURKE ACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E JOPPA RD SUITE PH-6
TOWSON MD
21286-3118
US

IV. Provider business mailing address

204 E JOPPA RD SUITE PH-6
TOWSON MD
21286-3118
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-6695
  • Fax: 410-321-8865
Mailing address:
  • Phone: 410-321-6695
  • Fax: 410-321-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02307
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: