Active NPI
Kenneth Robert Burke, MD
- Pediatrics Physician
- Essex, CT
National Provider Identifier
1164435871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 027239
- Practice address
- One Wildwood Medical Center
Essex, CT 06426 - Phone
- (860) 767-0168
- Fax
- (860) 767-1803
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 027239 | CT | Primary |
Addresses
Primary practice location
One Wildwood Medical Center
Essex, CT 06426
Mailing address
One Wildwood Medical Center
Essex, CT 06426
Phone (860) 767-0168
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 027239 | CT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wildwood Pediatrics and Adolescent Medicine LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Essex, CT
- NPI 1750405023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164435871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE WILDWOOD MEDICAL CENTER",
"city": "ESSEX",
"state": "CT",
"postal_code": "06426",
"telephone_number": "860-767-0168",
"fax_number": "860-767-1803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ONE WILDWOOD MEDICAL CENTER",
"city": "ESSEX",
"state": "CT",
"postal_code": "06426",
"telephone_number": "860-767-0168",
"fax_number": "860-767-1803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKE",
"first_name": "KENNETH",
"middle_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "027239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Essex, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.