1588640957 NPI number — RACHEL G BURKE DO

Table of content: RACHEL G BURKE DO (NPI 1588640957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588640957 NPI number — RACHEL G BURKE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
RACHEL
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRETT
Provider Other First Name:
RACHEL
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588640957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 PORTLAND ST.
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
SOUTH BERWICK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03908-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-384-9212
Provider Business Mailing Address Fax Number:
207-384-2008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 PORTLAND ST.
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
SOUTH BERWICK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03908-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-384-9212
Provider Business Practice Location Address Fax Number:
207-384-2008
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1840 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00311910 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 411830099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA16535 . This is a "HARVARD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 022979 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 8612007 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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