Provider Demographics
NPI:1245434141
Name:BURKE, LAUREN MARIE BRUBAKER (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE BRUBAKER
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:BRUBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:CB 7510
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-1021
Mailing Address - Fax:919-843-8740
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CB 7510
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-1021
Practice Address - Fax:919-843-8740
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-015582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFB3036870OtherDEA