Organization
ALTA ANATOMIC PATHOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME S BURKE M.D. (PRESIDENT)
(510) 204-1642
Entity
Organization
Contact information
Practice address
2450 ASHBY AVE, BERKELEY, CA 94705-2067
(510) 204-1642
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0022700
DHS MEDI-CAL
CA
Enumeration date
03/16/2006
Last updated
09/11/2025
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