1487670204 NPI number — GEORGE W BURKE III M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487670204 NPI number — GEORGE W BURKE III M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BURKE

Provider First Name:

GEORGE

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

III

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1487670204

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/14/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1000 BOULDERS PKWY

Provider Second Line Business Mailing Address:

SUITE 102

Provider Business Mailing Address City Name:

RICHMOND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23225-5545

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-320-4243

Provider Business Mailing Address Fax Number:

804-622-0552

Provider First Line Business Practice Location Address:

1603 SANTA ROSA RD

Provider Second Line Business Practice Location Address:

SUITE 101

Provider Business Practice Location Address City Name:

RICHMOND

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23229-5010

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-320-4243

Provider Business Practice Location Address Fax Number:

804-622-0552

Provider Enumeration Date:

07/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RP1001X , with the licence number:  0101020520 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 015974 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 59271 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 006895400 . This is a "BLACK LUNG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 2060296 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 30638 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 015974 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 021781 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4800154 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 81752 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 006082122 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110014425 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 557515 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".