Basic Information
| Provider Information | |||||||||
| NPI: | 1255311270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTOR | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952000 | ||||||||
| FaxNumber: | 5088537149 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTOR | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952000 | ||||||||
| FaxNumber: | 5088537149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 200883 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 04247226 | 01 | ONE HEALTH PLAN | OTHER | 500002311 | 01 | RAILROAD MEDICARE | OTHER | NP0719 | 01 | MEDICARE B | OTHER | NP0719 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266008 | 01 | TRICARE/CHAMPUS | OTHER | 0700380 | 05 | MA | MEDICAID | 8300309 | 01 | EVERCARE | OTHER | AA3454 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | NP0719 | 01 | BLUE SHIELD HMO BLUE | OTHER | NP0719 | 01 | BLUE SHIELD INDEMNITY | OTHER | 57692 | 01 | FALLON COMMUNITY HEALTH P | OTHER |