Provider Demographics
NPI:1255363362
Name:BURKE, ALAN M (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:M
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 1:1923 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4659
Mailing Address - Country:US
Mailing Address - Phone:215-677-3063
Mailing Address - Fax:215-677-3241
Practice Address - Street 1:1923 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4659
Practice Address - Country:US
Practice Address - Phone:215-677-3063
Practice Address - Fax:215-677-3241
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020937E207XX0004X, 2086S0129X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD75363Medicare UPIN
PA841608Medicare ID - Type Unspecified