Provider Demographics
NPI:1790745057
Name:BURKE, ROBERT MICHAEL SR (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:BURKE
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHURCH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2093
Mailing Address - Country:US
Mailing Address - Phone:774-255-1739
Mailing Address - Fax:774-255-1790
Practice Address - Street 1:40 CHURCH AVE STE 202
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2093
Practice Address - Country:US
Practice Address - Phone:774-255-1739
Practice Address - Fax:774-255-1790
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA585363A00000X
MA585363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000588201Medicare PIN
R91278Medicare UPIN
MA0005882Medicare PIN