Provider Demographics
NPI:1255311270
Name:BURKE, MARY E (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BURKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTOR
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-595-2000
Mailing Address - Fax:508-853-7149
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTOR
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-595-2000
Practice Address - Fax:508-853-7149
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
04247226OtherONE HEALTH PLAN
500002311OtherRAILROAD MEDICARE
NP0719OtherMEDICARE B
NP0719OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266008OtherTRICARE/CHAMPUS
MA0700380Medicaid
8300309OtherEVERCARE
AA3454OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTHREE RIVERS
NP0719OtherBLUE SHIELD HMO BLUE
NP0719OtherBLUE SHIELD INDEMNITY
57692OtherFALLON COMMUNITY HEALTH P
S36254Medicare UPIN
NP0719OtherBLUE SHIELD HMO BLUE