Provider Demographics
NPI:1437232675
Name:BURKE, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 BUSINESS CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5359
Mailing Address - Country:US
Mailing Address - Phone:800-762-9244
Mailing Address - Fax:786-672-6006
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5359
Practice Address - Country:US
Practice Address - Phone:800-762-9244
Practice Address - Fax:786-672-6006
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY423282084N0400X
NC2004014762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901242Medicaid
NC2042949AMedicare PIN
KY7100061550Medicaid
NC5901242Medicaid
KY1307435Medicare PIN
NC2042949AMedicare PIN
NC2042949Medicare ID - Type Unspecified
I35292Medicare ID - Type Unspecified