Provider Demographics
NPI:1740248236
Name:BURKE, ELIZABETH MARY (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:106 MILFORD ST STE 301
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6962
Practice Address - Country:US
Practice Address - Phone:410-546-4431
Practice Address - Fax:410-543-8259
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD36872207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD287001100Medicaid
MDD76163Medicare UPIN
MDH766070RMedicare ID - Type Unspecified
MD168118ZAH4Medicare PIN