Provider Demographics
NPI:1043585029
Name:BURKE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BURKE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-978-6061
Mailing Address - Street 1:8988 FERN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1635
Mailing Address - Country:US
Mailing Address - Phone:703-978-6061
Mailing Address - Fax:703-978-0291
Practice Address - Street 1:8988 FERN PARK DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1635
Practice Address - Country:US
Practice Address - Phone:703-978-6061
Practice Address - Fax:703-978-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101017927261QP2300X
VA0101025357261QP2300X
VA0101053539261QP2300X
VA0101240590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006727352Medicaid
VA010074941Medicaid
VA6712355Medicaid
VA006707033Medicaid
VA010074941Medicaid
VAB93007Medicare UPIN
VA006727352Medicaid