Provider Demographics
NPI:1629044987
Name:BURKE, ROBERT PATRICK (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
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 1:1 OXFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2651
Mailing Address - Country:US
Mailing Address - Phone:315-738-1820
Mailing Address - Fax:315-738-7908
Practice Address - Street 1:1 OXFORD RD STE 200
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2651
Practice Address - Country:US
Practice Address - Phone:315-738-1820
Practice Address - Fax:315-728-7908
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10042611OtherCDPHP ID NUMBER
NY01951179Medicaid
NY571169454OtherBLUE SHIELD
699361OtherMVP PAYEE NUMBER
699361OtherMVP PAYEE NUMBER
H01110Medicare UPIN
DA5839Medicare ID - Type UnspecifiedRAILROAD MEDICARE