Provider Demographics
NPI:1376516260
Name:BURGESS, HENRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:E
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 LEES GAP RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-3869
Mailing Address - Country:US
Mailing Address - Phone:540-682-3082
Mailing Address - Fax:540-779-7889
Practice Address - Street 1:405 E LABURNUM AVE STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2134
Practice Address - Country:US
Practice Address - Phone:540-200-8821
Practice Address - Fax:540-779-7889
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC159147207Q00000X
SC81686207Q00000X
ARE-11833207Q00000X
NC201803048207Q00000X
VA0101230868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005605113Medicaid
441912OtherANTHEM
VA5617456Medicaid
VA1376516260Medicaid
441914OtherANTHEM
VA080171551OtherMEDICARE RAILROAD
VA005611211Medicaid
VA441913OtherANTHEM
VA001175C04Medicare PIN
VA1376516260Medicaid
VAVVA800AMedicare PIN
VA005605113Medicaid
VA5617456Medicaid
VA005611211Medicaid
VA080007698Medicare PIN