Healthcare Provider Details

I. General information

NPI: 1063632990
Provider Name (Legal Business Name): EMILY BURKE RIVET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY BURKE DISKIN MD

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST DEPT. OF SURGERY/BARIATRIC & GASTROINTESTINAL
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 780126
PHILADELPHIA PA
19178
US

V. Phone/Fax

Practice location:
  • Phone: 804-327-8001
  • Fax: 804-327-8002
Mailing address:
  • Phone: 804-922-4844
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101243401
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101243401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: