Provider Demographics
NPI:1215023858
Name:BURKETT, HOWARD WAYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:WAYNE
Last Name:BURKETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BROOKWOOD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-9575
Mailing Address - Country:US
Mailing Address - Phone:717-249-9505
Mailing Address - Fax:717-249-9689
Practice Address - Street 1:13 BROOKWOOD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-9575
Practice Address - Country:US
Practice Address - Phone:717-249-9505
Practice Address - Fax:717-249-9689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003435-R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU593396Medicare ID - Type Unspecified
PAT91593Medicare UPIN