Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD024506E | PA |
Y | 111NI0900X | Internist | MD024506E | PA |
N | 207RG0300X | Geriatric Medicine | MD024506E | PA |
NPI | 1083694442 |
---|---|
Provider Name | Dr. M Susan Burke |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Wynnewood, PA 19096-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 24/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
232359401 | MAIN LINE HEALTHCARE (01) | PA |
B96733 | (02) |