Healthcare Provider Details

I. General information

NPI: 1104212026
Provider Name (Legal Business Name): AIDAN MICHAEL BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

3800 RESERVOIR RD NW DEPT OF RADIATION ONCOLOGY
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-1888
  • Fax:
Mailing address:
  • Phone: 202-444-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2020-00416
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: