Provider Demographics
NPI:1528057668
Name:BURKE, PATRICK DECLAN (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DECLAN
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CENTRAL PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4932
Mailing Address - Country:US
Mailing Address - Phone:540-785-8866
Mailing Address - Fax:540-785-2676
Practice Address - Street 1:1420 CENTRAL PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4932
Practice Address - Country:US
Practice Address - Phone:540-785-8866
Practice Address - Fax:540-785-2676
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101019596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B05272Medicare UPIN