Provider Demographics
NPI:1053462820
Name:BURKE, PATRICK G (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:G
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 1:2191 MOWRY AVE
Mailing Address - Street 2:600C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-792-4373
Mailing Address - Fax:510-792-3420
Practice Address - Street 1:2191 MOWRY AVE
Practice Address - Street 2:600C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-792-4373
Practice Address - Fax:510-792-3420
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G739340Medicare ID - Type Unspecified
G03662Medicare UPIN