Provider Demographics
NPI:1124160841
Name:WILLIAM A BURKE MD PC
Entity type:Organization
Organization Name:WILLIAM A BURKE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-492-5626
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-0397
Mailing Address - Country:US
Mailing Address - Phone:315-492-5626
Mailing Address - Fax:315-492-5306
Practice Address - Street 1:4900 BROAD ROAD SUITE 1B
Practice Address - Street 2:COMMUNITY GENERAL HOSPITAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5626
Practice Address - Fax:315-492-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00487316Medicaid
C59178Medicare UPIN
NY00487316Medicaid