Healthcare Provider Details

I. General information

NPI: 1053666198
Provider Name (Legal Business Name): JESSICA ABBATE BURNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 HARROUN RD STE 160
SYLVANIA OH
43560-2174
US

IV. Provider business mailing address

5308 HARROUN RD STE 160
SYLVANIA OH
43560-2174
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-5668
  • Fax: 419-885-6919
Mailing address:
  • Phone: 419-824-5668
  • Fax: 419-885-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301101487
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35137362
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: