Provider Demographics
NPI:1417223181
Name:BURKE, EDMUND C JR (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:C
Last Name:BURKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:246 NORTHLAND DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3441
Mailing Address - Country:US
Mailing Address - Phone:330-723-9600
Mailing Address - Fax:330-722-1446
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3441
Practice Address - Country:US
Practice Address - Phone:330-723-9600
Practice Address - Fax:330-722-1446
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-06-5517B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry