Healthcare Provider Details

I. General information

NPI: 1679514111
Provider Name (Legal Business Name): LEAH WEYERTS BURKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH KAE WEYERTS MD

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 COLCHESTER AVE VERMONT REGIONAL GENETICS CENTER
BURLINGTON VT
05401-1417
US

IV. Provider business mailing address

112 COLCHESTER AVE VERMONT REGIONAL GENETICS CENTER
BURLINGTON VT
05401-1417
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4310
  • Fax: 802-847-4664
Mailing address:
  • Phone: 802-847-4310
  • Fax: 802-847-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number0420010012
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420010012
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: