Provider Demographics
NPI:1083611826
Name:BURKE, PHILIP R (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4808
Mailing Address - Country:US
Mailing Address - Phone:617-983-0280
Mailing Address - Fax:617-934-1789
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-983-0280
Practice Address - Fax:617-934-1789
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2174952084S0012X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2099489Medicaid
MAJ28796OtherBCBS OF MA
MA468341OtherTUFTS HEALTH PLAN
MA2099489Medicaid
A38198Medicare PIN