Provider Demographics
NPI:1588851901
Name:DENISE A. BURKE M.D. P.C.
Entity Type:Organization
Organization Name:DENISE A. BURKE M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-779-4575
Mailing Address - Street 1:749 GOLF VIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9654
Mailing Address - Country:US
Mailing Address - Phone:541-779-4575
Mailing Address - Fax:
Practice Address - Street 1:749 GOLF VIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9654
Practice Address - Country:US
Practice Address - Phone:541-779-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-30
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17669207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000BLCGBOtherMEDICARE NUMBER
OR073486Medicaid
OR073486Medicaid