Healthcare Provider Details

I. General information

NPI: 1699758623
Provider Name (Legal Business Name): ROBERT T BURKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 12/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 CRANSTON ST
PROVIDENCE RI
02907-2406
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0580
  • Fax: 401-444-0428
Mailing address:
  • Phone: 401-444-0400
  • Fax: 401-444-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD09245
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: