Provider Demographics
NPI:1053400648
Name:DENSHAW-BURKE, MARY T (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:DENSHAW-BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MSB 4413
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-3060
Mailing Address - Fax:484-476-2602
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MSB 4413
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-3060
Practice Address - Fax:484-476-2602
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026730E207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB96809Medicare UPIN