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General NPI Number Information
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NPI Number | 1760475362
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Entity Type | Individual
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Provider Name | EDWIN KEITH BURKETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 101 DONALD ROSS DR
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City | RALEIGH
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State | NC
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Zip | 27610-2593
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Country | US
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Telephone | 919-250-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 101 DONALD ROSS DR
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City | RALEIGH
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State | NC
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Zip | 27610-2593
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Country | US
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Telephone | 919-250-3320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G78675
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101243098
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2021-00773
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License Number State | NC
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