Provider Demographics
NPI:1609019314
Name:BURGESS, JESSICA ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROBIN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ROBIN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8960
Mailing Address - Fax:757-446-5197
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8960
Practice Address - Fax:757-446-5197
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012578672086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609019314OtherCOVENTRY NETWORK
VA1609019314OtherUSA MANAGED CARE
VA1609019314OtherCORVEL
VA1609019314OtherVIRGINIA HEALTH NETWORK
VA1609019314Medicaid
NC1609019314Medicaid
VA10150094OtherOPTIMA HEALTH
VA1609019314OtherMULTIPLAN
VA1609019314OtherANTHEM BC/BS
VA1609019314OtherCIGNA
VA-019OtherTRICARE/CHAMPUS
VA1609019314OtherUNITED HEALTHCARE
VA1609019314OtherAETNA
VA1609019314OtherVIRGINIA PREMIER HEALTH PLAN
VA1609019314OtherCOVENTRY NETWORK
VAVVH638AMedicare PIN