Basic Information
| Provider Information | |||||||||
| NPI: | 1003010463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGART | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ELDER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 550 WHITE OAK ST | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272034710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366251360 | ||||||||
| FaxNumber: | 3366251889 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 WHITE OAK ST | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272034710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366251360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 52437 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2012-02044 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6039935 | 01 | TN | BCBS TENNESSEE | OTHER | 5907686 | 05 | NC | MEDICAID | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 1003010463 | 05 | VA | MEDICAID | 2180421 | 01 | VA | UHC/MAMSI | OTHER | -002 -003 | 01 | VA | TRICARE/CHAMPUS | OTHER | 302884 | 01 | VA | ANTHEM PFM | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 10022001 | 01 | VA | SENTARA/OPTIMA | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | Q000626 | 05 | TN | MEDICAID | 07868 | 01 | NC | BC/BS | OTHER | 302882 | 01 | VA | ANTHEM | OTHER |