Provider Demographics
NPI:1588629380
Name:BURKE, BRENDAN F (MD)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:F
Last Name:BURKE
Suffix:
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 1:5530 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4446
Mailing Address - Country:US
Mailing Address - Phone:301-652-7623
Mailing Address - Fax:301-718-6234
Practice Address - Street 1:5530 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 850
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4446
Practice Address - Country:US
Practice Address - Phone:301-652-7623
Practice Address - Fax:301-718-6234
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041260207V00000X
DCMD18798207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1244327OtherUNITED HEALTHCARE
497476OtherNCPPO
2132061OtherMAMSI LIFE HEALTH
E83708Medicare UPIN
2132061OtherMAMSI LIFE HEALTH