Provider Demographics
NPI:1659307551
Name:BURKE, GRETCHEN SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:SMITH
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 1:9 HIGH MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1038
Mailing Address - Country:US
Mailing Address - Phone:585-218-9838
Mailing Address - Fax:
Practice Address - Street 1:353 ISLAND COTTAGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-2349
Practice Address - Country:US
Practice Address - Phone:585-225-2610
Practice Address - Fax:585-581-1396
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1924872080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010192487OtherEXCELLUS BLUE CHOICE
NYP010192487OtherEXCELLUS BL CRSS BL SHLD
NY7702366OtherCOMMERCIAL INSURANCES
NY5018472OtherAETNA
NY01685212Medicaid