Healthcare Provider Details

I. General information

NPI: 1609019314
Provider Name (Legal Business Name): JESSICA ROBIN BURGESS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JESSICA ROBIN JONES

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE SUITE 610
NORFOLK VA
23507-1914
US

IV. Provider business mailing address

PO BOX 936 EVMS MEDICAL GROUP
NORFOLK VA
23501-0936
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-8960
  • Fax: 757-446-5197
Mailing address:
  • Phone: 757-446-8960
  • Fax: 757-446-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101257867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: