Individual
DR. DIANE A BOURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7B JOHNSON RD, LATHAM, NY 12110-3003
(518) 782-7733
(518) 782-0800
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
173530
NY
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
173530
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01820997
—
NY
01
—
042ZE1
EMPIRE BLUECROSS
NY
01
—
091231000203
FIDELIS
NY
01
—
143257
GHI/HMO
NY
01
—
5780670
AETNA
NY
01
—
9042526
MVP HELATHCARE
NY
01
—
PRC110027743
CDPHP
NY
Enumeration date
04/14/2006
Last updated
01/18/2018
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