Organization Name: | BURKE PEDIATRICS, LLC |
NPI Number: | 1043585029 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FREDRIC GARNER (MANGING PARTNER) |
Mailing Address: | 8988 Fern Park Dr Burke |
State: | VA US |
Postal Code: | 220151635 |
Phone Number: | 7039786061 |
Fax Number: | 7039780291 |
NPI Enumeration Date: | 03/09/2012 |
NPI Last Update Date: | 03/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 0101025357 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |