Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 221036 | NY |
NPI | 1174513287 |
---|---|
Provider Name | Christine Burke |
First Address | Scranton, PA 18501-0031 |
Second Address | Scranton, PA 18509-3023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 17/04/2015 |