Provider Demographics
NPI:1760475362
Name:BURKETT, EDWIN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:KEITH
Last Name:BURKETT
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 1:101 DONALD ROSS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2593
Mailing Address - Country:US
Mailing Address - Phone:919-250-3320
Mailing Address - Fax:
Practice Address - Street 1:101 DONALD ROSS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2593
Practice Address - Country:US
Practice Address - Phone:919-250-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78675207Q00000X
VA0101243098207Q00000X
NC2021-00773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine