Healthcare Provider Details

I. General information

NPI: 1255363362
Provider Name (Legal Business Name): ALAN M BURKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 WELSH RD
PHILADELPHIA PA
19115-4659
US

IV. Provider business mailing address

1923 WELSH RD
PHILADELPHIA PA
19115-4659
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-3063
  • Fax: 215-677-3241
Mailing address:
  • Phone: 215-677-3063
  • Fax: 215-677-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD020937E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD020937E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD020937E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: