DR. DIANE A BOURKE M.D. - NPI 1124082375 - Pediatrics in Latham, NY

Q: What is Diane Bourke's NPI number?

The NPI number for Diane Bourke is 1124082375. It was assigned to this individual provider in the NPPES registry on April 14, 2006.

Q: What is Diane Bourke's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Developmental - Behavioral Pediatrics, with taxonomy code 2080P0006X.

Q: When was this NPI record last updated?

The NPPES record for Diane Bourke was last updated on January 18, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Dr. Diane A Bourke M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DIANE A BOURKE M.D. (NPI 1124082375) is an individual developmental - behavioral pediatrics provider in Latham, New York, licensed in New York (173530) and active in the NPI registry since April 2006.

NPPES Registry Identity

NPI1124082375

Entity TypeIndividualFemale

Primary Taxonomy2080P0006X

Provider Legal NameDR. DIANE A BOURKECredential: M.D.

Location Address7B JOHNSON RDLatham, NY 12110-3003

Mailing Address711 Troy Schenectady Rd Ste 203Latham, NY 12110-2461 · (518) 782-3700 · Fax (518) 782-3799

Phone(518) 782-7733

Fax(518) 782-0800

Sole ProprietorNo

Enumeration DateApril 14, 2006

Last NPPES UpdateJanuary 18, 2018

✔ NPI 1124082375 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Developmental - Behavioral PediatricsAllopathic & Osteopathic Physicians

Taxonomy Code2080P0006X

License✔ Licensed in NY · 173530

Definition

A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development.

Also ListedSpecialistTaxonomy 174400000X · License 173530 (NY)

7B JOHNSON RD, Latham, NY 12110

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Other Identifiers 7

Medicaid01820997NY

Other143257NY · Ghi/hmo

OtherPRC110027743NY · Cdphp

Other091231000203NY · Fidelis

Other5780670NY · Aetna

Other9042526NY · Mvp Helathcare

Other042ZE1NY · Empire Bluecross

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CATHERINE CANARY M.D.

Pediatrics (Developmental - Behavioral Pediatrics)