Provider Demographics
NPI:1972567402
Name:BURKE, SEAN DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:DAVID
Last Name:BURKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2178
Mailing Address - Country:US
Mailing Address - Phone:717-242-1391
Mailing Address - Fax:717-242-1747
Practice Address - Street 1:16 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2178
Practice Address - Country:US
Practice Address - Phone:717-242-1391
Practice Address - Fax:717-242-1747
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009989L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018484880003Medicaid
PA049871SS7Medicare ID - Type Unspecified
PA0018484880003Medicaid