Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 56750 | MA |
N | 208600000X | Surgeon | 56750 | MA |
Y | 2086S0102X | Surgical Critical Care | 56750 | MA |
NPI | 1184687303 |
---|---|
Provider Name | Dr. Peter A Burke |
First Address | Boston, MA 02119 |
Second Address | Boston, MA 02118-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110048844A | (05) | MA |