Provider Demographics
NPI:1720151855
Name:BURKE, JAMES PAUL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE STE E1
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4817
Mailing Address - Country:US
Mailing Address - Phone:814-946-9150
Mailing Address - Fax:814-946-1397
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:BUILDING F-3
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-946-9150
Practice Address - Fax:814-946-1397
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066471L207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH25796Medicare UPIN