Provider Demographics
NPI:1619997665
Name:BURKE, NADINE (MD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 THIRD STREET
Mailing Address - Street 2:BLDG. 2, SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124
Mailing Address - Country:US
Mailing Address - Phone:415-600-1990
Mailing Address - Fax:415-826-9307
Practice Address - Street 1:3450 THIRD STREET
Practice Address - Street 2:BLDG. 2, SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124
Practice Address - Country:US
Practice Address - Phone:415-600-1990
Practice Address - Fax:415-826-9307
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A840780OtherBLUE SHIELD
CA00A840780Medicaid