Healthcare Provider Details

I. General information

NPI: 1598865461
Provider Name (Legal Business Name): MAUREEN R BURKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CAMPBELL BOULEVARD
WHITE MARSH MD
21236
US

IV. Provider business mailing address

110 NNPTC CIR
GOOSE CREEK SC
29445-6314
US

V. Phone/Fax

Practice location:
  • Phone: 443-442-2300
  • Fax: 443-442-2360
Mailing address:
  • Phone: 843-794-6359
  • Fax: 843-794-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0063474
License Number StateMD

VII. Legacy identifiers

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

# 1
Identifier409122100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: