Basic Information
| Provider Information | |||||||||
| NPI: | 1538459656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 ROUND HILL RD | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023642188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7366888749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 295 VARNUM AVE | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018542134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789376000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME138154 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 53330 | TN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 25MA09098600 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 12915 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 278733 | MA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.