Healthcare Provider Details

I. General information

NPI: 1447224076
Provider Name (Legal Business Name): JENNIFER KATHLYNNE BURKE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 W BALTIMORE PIKE
MEDIA PA
19063-5104
US

IV. Provider business mailing address

1068 W BALTIMORE PIKE
MEDIA PA
19063-5104
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-2580
  • Fax:
Mailing address:
  • Phone: 484-337-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS014108
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS014108
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberOS014108
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: