Provider Demographics
NPI:1386770527
Name:BURKE, BRIAN T (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:BURKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4567 CROSSROADS PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:2209 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4308
Practice Address - Country:US
Practice Address - Phone:315-798-8171
Practice Address - Fax:315-734-3084
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC700035112085R0202X
NY2636482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03442528Medicaid
NYJ400071663Medicare PIN