Provider Demographics
NPI:1316068166
Name:DEBORAH A BURKE MD PLC
Entity type:Organization
Organization Name:DEBORAH A BURKE MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-452-4084
Mailing Address - Street 1:2810 W SAINT ISABEL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6375
Mailing Address - Country:US
Mailing Address - Phone:727-585-7020
Mailing Address - Fax:727-518-0762
Practice Address - Street 1:360 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2335
Practice Address - Country:US
Practice Address - Phone:727-584-8777
Practice Address - Fax:727-584-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78541261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58651XMedicare ID - Type Unspecified
FLH40259Medicare UPIN