Provider Demographics
NPI:1487765830
Name:BURKE FAMILY PRACTICE P.C.
Entity type:Organization
Organization Name:BURKE FAMILY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TWOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-978-4200
Mailing Address - Street 1:9409 OLD BURKE LAKE RD # B
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3127
Mailing Address - Country:US
Mailing Address - Phone:703-978-4200
Mailing Address - Fax:703-503-8263
Practice Address - Street 1:9409 OLD BURKE LAKE RD # B
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3127
Practice Address - Country:US
Practice Address - Phone:703-978-4200
Practice Address - Fax:703-503-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA405805Medicare ID - Type Unspecified