Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2786 | WV |
NPI | 1508975798 |
---|---|
Provider Name | Dennis A. Burke |
First Address | Lewisburg, WV 24901 |
Second Address | Lewisburg, WV 24901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 29/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810026766 | (05) | WV |