Provider Demographics
NPI:1790871085
Name:BURKE, CASEY JAMES (DO)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JAMES
Last Name:BURKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-2501
Mailing Address - Country:US
Mailing Address - Phone:570-483-4603
Mailing Address - Fax:570-319-1250
Practice Address - Street 1:109 TERRACE DR
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-2501
Practice Address - Country:US
Practice Address - Phone:570-483-4603
Practice Address - Fax:570-319-1250
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012292207XS0106X
MI5101014881207XS0106X
CT044194207XS0106X
PAOS014855207XS0106X, 207X00000X
NE540207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070309913Medicaid
MO2014012292OtherMO LICENSE
MO148380094OtherMEDICARE PTAN FOR FDC
NE281434Medicare PIN
NEP00409516Medicare PIN