Provider Demographics
NPI:1992702138
Name:BURKE, BRENDA J (DO)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:BURKE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:19 FRIENDSHIP ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2200
Mailing Address - Country:US
Mailing Address - Phone:401-845-4332
Mailing Address - Fax:401-848-6084
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-845-4332
Practice Address - Fax:401-848-6084
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2012-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIDO 00575207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7056546Medicaid
RI411896OtherRI BLUE CHIP
RI27785-7OtherRI BC/BS
I12603Medicare UPIN
RI27785-7OtherRI BC/BS