Provider Demographics
NPI:1427408186
Name:BURKE, JACQUELINE (VMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:PERKIOMENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18074-9552
Mailing Address - Country:US
Mailing Address - Phone:610-754-1155
Mailing Address - Fax:
Practice Address - Street 1:1126 SNYDER RD
Practice Address - Street 2:
Practice Address - City:PERKIOMENVILLE
Practice Address - State:PA
Practice Address - Zip Code:18074-9552
Practice Address - Country:US
Practice Address - Phone:610-754-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABV006142-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist