Provider Demographics
NPI:1154383602
Name:BURKE, LAUREEN ANNE (MD)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:ANNE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2623
Mailing Address - Country:US
Mailing Address - Phone:585-730-7024
Mailing Address - Fax:585-563-8791
Practice Address - Street 1:2275 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2623
Practice Address - Country:US
Practice Address - Phone:585-730-7024
Practice Address - Fax:585-563-8791
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216682-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106821CKOtherPREFERRED CARE
NY000919293005OtherBC/BS OF WESTERN NEW YORK
NY000919293006OtherBC/BS OF WESTERN NEW YORK
NYP030216682OtherBC/BS
NY000919293004OtherBC/BS OF WESTERN NEW YORK
NY0296822OtherGHI
NYP010216682OtherBLUE CHOICE
NY02178403Medicaid
NY7047288OtherAETNA
NY02178403Medicaid
NYP010216682OtherBLUE CHOICE