MEDICARE: DR. WILLIAM A BURKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	27573	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	70008970	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	20046	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1609873835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A BURKE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751069
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1069
Country	:	US
Telephone Number	:	252-744-3520
Fax Number	:	252-744-3194

Provider Business Practice Location Address
First Line	:	817 MOYE BLVD FL. 3
Second Line	:	ECU PHYSICIANS DERMETOLOGY MOYE MEDICAL CENTER #2
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2849
Country	:	US
Telephone Number	:	252-744-3109
Fax Number	:	252-744-2096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	11/19/2011

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Directions to “ DR. WILLIAM A BURKE M.D.” Practice Location

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