Provider Demographics
NPI:1962597831
Name:BURKE, ROSALIA C (MD)
Entity type:Individual
Prefix:
First Name:ROSALIA
Middle Name:C
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSALIA
Other - Middle Name:CHIPELO
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:1501 RIVER POINTE DR
Practice Address - Street 2:STE 120
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2656
Practice Address - Country:US
Practice Address - Phone:936-539-4700
Practice Address - Fax:936-539-6618
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7320207Y00000X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1472069OtherBEECHSTREET
TX162913102Medicaid
TX162913102Medicaid
TXTXB109684Medicare PIN