Provider Demographics
NPI:1821008632
Name:BURFOOT, KEISHA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:L
Last Name:BURFOOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 HENNEMAN DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2503
Mailing Address - Country:US
Mailing Address - Phone:757-395-4455
Mailing Address - Fax:757-233-1795
Practice Address - Street 1:5280 HENNEMAN DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2503
Practice Address - Country:US
Practice Address - Phone:757-395-4455
Practice Address - Fax:757-233-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00620059Medicaid
VA00620059Medicaid
VA160001771Medicare ID - Type UnspecifiedMEDICARE ID NUMBER