Provider Demographics
NPI:1588620330
Name:BURKE, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:NORTH VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04962-0247
Mailing Address - Country:US
Mailing Address - Phone:207-873-6173
Mailing Address - Fax:207-873-4514
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04989-3107
Practice Address - Country:US
Practice Address - Phone:207-873-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME010930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003751OtherANTHEM
5225252OtherAETNA NON HMO
0141319OtherAETNA HMO
ME280480099Medicaid
110025993OtherRAILROAD
C66280OtherHARVARD PILGRIM
ME280480099Medicaid
110025993OtherRAILROAD