Provider Demographics
NPI:1700837515
Name:BURKE, CHARLES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:231 SUTTON ST
Mailing Address - Street 2:UNIT 1D
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1620
Mailing Address - Country:US
Mailing Address - Phone:978-686-3877
Mailing Address - Fax:978-686-9586
Practice Address - Street 1:231 SUTTON ST
Practice Address - Street 2:UNIT 1D
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1620
Practice Address - Country:US
Practice Address - Phone:978-686-3877
Practice Address - Fax:978-686-9586
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA34455208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6164412Medicaid
MA9719911Medicaid
MA9719911Medicaid
MAM12943Medicare ID - Type UnspecifiedGROUP
MABUD02051Medicare ID - Type Unspecified