MEDICARE: SCOTT VASSAR BURGESS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	0101238311	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609854835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT VASSAR BURGESS M.D.

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 KINGS WAY
Second Line	:	SUITE 3200
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2505
Country	:	US
Telephone Number	:	757-253-0051
Fax Number	:	757-229-9526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	09/30/2013

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Directions to “ SCOTT VASSAR BURGESS M.D.” Practice Location

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