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General NPI Number Information
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NPI Number | 1972897684
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Entity Type | Individual
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Provider Name | LOLA J BURKE MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 428 MORGANTOWN ST STE 1
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City | KINGWOOD
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State | WV
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Zip | 26537-1140
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Country | US
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Telephone | 304-329-7124
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Fax | 304-329-7092
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Provider Business Mailing Address
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Address Line | 150 MEMORIAL DR
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City | KINGWOOD
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State | WV
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Zip | 26537-1141
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Country | US
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Telephone | 304-329-1400
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Fax | 304-329-1175
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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 | 25293
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License Number State | WV
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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 | 39113
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 25293
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License Number State | WV
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