Provider Demographics
NPI:1003010463
Name:BURGART, JENNIFER ELDER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELDER
Last Name:BURGART
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 1:550 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4710
Mailing Address - Country:US
Mailing Address - Phone:336-625-1360
Mailing Address - Fax:336-625-1889
Practice Address - Street 1:550 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4710
Practice Address - Country:US
Practice Address - Phone:336-625-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52437207Q00000X
NC2012-02044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6039935OtherBCBS TENNESSEE
NC5907686Medicaid
VAPAROtherCIGNA
VAPAROtherAETNA
VAPAROtherVA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA1003010463Medicaid
VA2180421OtherUHC/MAMSI
VA-002 -003OtherTRICARE/CHAMPUS
VA302884OtherANTHEM PFM
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherMULTIPLAN
VAPAROtherCORVEL/CORCARE
VA10022001OtherSENTARA/OPTIMA
VAPAROtherUSA MANAGED CARE
TNQ000626Medicaid
NC07868OtherBC/BS
VA302882OtherANTHEM
VAPAROtherUSA MANAGED CARE
VA302882OtherANTHEM
VAPAROtherAETNA