Provider Demographics
NPI:1588640957
Name:BURKE, RACHEL G (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:G
Last Name:BURKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:E
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:57 PORTLAND ST.
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1203
Mailing Address - Country:US
Mailing Address - Phone:207-384-9212
Mailing Address - Fax:207-384-2008
Practice Address - Street 1:57 PORTLAND ST.
Practice Address - Street 2:SUITE 2A
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1203
Practice Address - Country:US
Practice Address - Phone:207-384-9212
Practice Address - Fax:207-384-2008
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00311910OtherMEDICARE RAILROAD
ME411830099Medicaid
MEAA16535OtherHARVARD
ME022979OtherANTHEM
ME8612007OtherCIGNA
MEAA16535OtherHARVARD
ME8612007OtherCIGNA