Healthcare Provider Details

I. General information

NPI: 1487765830
Provider Name (Legal Business Name): BURKE FAMILY PRACTICE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409 OLD BURKE LAKE RD # B
BURKE VA
22015-3127
US

IV. Provider business mailing address

9409 OLD BURKE LAKE RD # B
BURKE VA
22015-3127
US

V. Phone/Fax

Practice location:
  • Phone: 703-978-4200
  • Fax: 703-503-8263
Mailing address:
  • Phone: 703-978-4200
  • Fax: 703-503-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN TWOMEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 703-978-4200