Healthcare Provider Details

I. General information

NPI: 1154377752
Provider Name (Legal Business Name): KAREN A BURKE-HAYNES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 RAVEN RIDGE RD STE 105
RALEIGH NC
27614-6487
US

IV. Provider business mailing address

5400 TRINITY RD STE 105
RALEIGH NC
27607-6001
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-0543
  • Fax: 919-235-0542
Mailing address:
  • Phone: 919-851-2174
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0093-00662
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: