Healthcare Provider Details

I. General information

NPI: 1063462240
Provider Name (Legal Business Name): TIMOTHY BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD RADIOLOGY 114
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD RADIOLOGY 114
RICHMOND VA
23249-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5114
  • Fax: 804-675-5236
Mailing address:
  • Phone: 804-675-5114
  • Fax: 804-675-5236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number0101-031800
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number0101-031800
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: