Provider Demographics
NPI:1366633034
Name:BURGE-MARTIN, TOVA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:TOVA
Middle Name:LYNN
Last Name:BURGE-MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TOVA
Other - Middle Name:LYNN
Other - Last Name:BURGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 COWARDIN AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2078
Mailing Address - Country:US
Mailing Address - Phone:804-231-9691
Mailing Address - Fax:
Practice Address - Street 1:101 COWARDIN AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2078
Practice Address - Country:US
Practice Address - Phone:804-231-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248775207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508004Medicaid