Provider Demographics
NPI:1619963378
Name:BURKE, CYRIL O III (MD)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:O
Last Name:BURKE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-521-9620
Mailing Address - Fax:401-521-4651
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-521-9620
Practice Address - Fax:401-521-4651
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2011-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD71382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI201768OtherBLUE CROSS
RI203480OtherBLUE CHIP
RI05-00152OtherUNITED HEALTH
F48237Medicare UPIN
RI201768OtherBLUE CROSS