Basic Information
Provider Information
NPI: 1003010463
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURGART
FirstName: JENNIFER
MiddleName: ELDER
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X2012-02044NCY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X52437TNN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
PAR01VAAETNAOTHER
PAR01VAMULTIPLANOTHER
PAR01VACORVEL/CORCAREOTHER
0786801NCBC/BSOTHER
590768605NC MEDICAID
Q00062605TN MEDICAID
-002 -00301VATRICARE/CHAMPUSOTHER
1002200101VASENTARA/OPTIMAOTHER
30288401VAANTHEM PFMOTHER
30288201VAANTHEMOTHER
PAR01VACIGNAOTHER
PAR01VAUSA MANAGED CAREOTHER
PAR01VAFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRYOTHER
100301046305VA MEDICAID
603993501TNBCBS TENNESSEEOTHER
PAR01VAVA HEALTH NETWORKOTHER
218042101VAUHC/MAMSIOTHER
PAR01VAVIRGINIA PREMIER HEALTHOTHER


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