Healthcare Provider Details

I. General information

NPI: 1609873835
Provider Name (Legal Business Name): WILLIAM A BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 MOYE BLVD FL. 3 ECU PHYSICIANS DERMETOLOGY MOYE MEDICAL CENTER #2
GREENVILLE NC
27834-2849
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3109
  • Fax: 252-744-2096
Mailing address:
  • Phone: 252-744-3520
  • Fax: 252-744-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27573
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: