Provider Demographics
NPI:1831545714
Name:BURKA, LINDA (LDN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BURKA
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 REDDING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2665
Mailing Address - Country:US
Mailing Address - Phone:301-651-2044
Mailing Address - Fax:
Practice Address - Street 1:55 REDDING RIDGE DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2665
Practice Address - Country:US
Practice Address - Phone:301-651-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3989133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist