Provider Demographics
NPI:1689728529
Name:BURKE, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:2173 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04654-6024
Mailing Address - Country:US
Mailing Address - Phone:207-255-6670
Mailing Address - Fax:
Practice Address - Street 1:2173 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654-6024
Practice Address - Country:US
Practice Address - Phone:207-255-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME8966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME8966OtherMEDICAL LICENCE NUMBER
ME8966OtherMEDICAL LICENCE NUMBER