Provider Demographics
NPI:1588835722
Name:BURKE, RYAN TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TREVOR
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 263
Mailing Address - Street 2:
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0263
Mailing Address - Country:US
Mailing Address - Phone:631-804-1942
Mailing Address - Fax:
Practice Address - Street 1:8835 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2718
Practice Address - Country:US
Practice Address - Phone:215-248-8508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247879207P00000X
PAMD443782207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026262440001Medicaid
PA225097Medicare PIN