Provider Demographics
NPI:1821782061
Name:BURKE, AIDAN THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:THOMAS
Last Name:BURKE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN ST # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:617-639-9986
Mailing Address - Fax:617-499-5212
Practice Address - Street 1:300 MOUNT AUBURN ST STE 413
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5665
Practice Address - Country:US
Practice Address - Phone:617-639-9986
Practice Address - Fax:617-499-5212
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA9466363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical