Healthcare Provider Details

I. General information

NPI: 1568437481
Provider Name (Legal Business Name): PAUL BRIAN BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E BISHOP ST
BELLEFONTE PA
16823-2319
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-3034
US

V. Phone/Fax

Practice location:
  • Phone: 814-355-9743
  • Fax: 814-353-3500
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039789E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: