Provider Demographics
NPI:1659330553
Name:BURKE, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1460
Mailing Address - Fax:304-691-1453
Practice Address - Street 1:300 CORPORATE CENTER DRIVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560
Practice Address - Country:US
Practice Address - Phone:304-691-1800
Practice Address - Fax:304-691-6736
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-01-23
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Provider Licenses
StateLicense IDTaxonomies
WV19438207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0093860000Medicaid
OH2076426Medicaid
KY64942501Medicaid
KY64942501Medicaid
WV0863673Medicare PIN