1902848179 NPI number — DR. VALERIE BURKE M.D.,F.A.C.O.G.

Table of content: DR. VALERIE BURKE M.D.,F.A.C.O.G. (NPI 1902848179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902848179 NPI number — DR. VALERIE BURKE M.D.,F.A.C.O.G.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
VALERIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,F.A.C.O.G.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902848179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29526-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-248-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 PALMETTO POINTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29571-6721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-423-2400
Provider Business Practice Location Address Fax Number:
843-423-0704
Provider Enumeration Date:
06/12/2006

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: 207V00000X , with the licence number:  18686 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 58-2478957 . This is a "TAX ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP2572 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57-0679807 . This is a "TAX ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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