Provider Demographics
NPI:1679514111
Name:BURKE, LEAH WEYERTS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:WEYERTS
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:KAE
Other - Last Name:WEYERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:112 COLCHESTER AVE
Mailing Address - Street 2:VERMONT REGIONAL GENETICS CENTER
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1417
Mailing Address - Country:US
Mailing Address - Phone:802-847-4310
Mailing Address - Fax:802-847-4664
Practice Address - Street 1:112 COLCHESTER AVE
Practice Address - Street 2:VERMONT REGIONAL GENETICS CENTER
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1417
Practice Address - Country:US
Practice Address - Phone:802-847-4310
Practice Address - Fax:802-847-4664
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010012207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2253Medicaid
VTOVN2253Medicaid