Basic Information
| Provider Information | |||||||||
| NPI: | 1992703417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 WADSWORTH DR | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232364500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 WADSWORTH DR | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232364500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 12/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0905X | 0101230663 | VA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 6501591 | 05 | VA | MEDICAID |