Burgess, Jason Shade

Burgess, Jason Shade is an individual health care provider with primary practice located at 2001 Vail Avenue Ste 320, Charlotte NC 28207-1107. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Burgess, Jason Shade can be contacted via phone (704) 333-0741.

Contact Information

Primary practice address
2001 Vail Avenue Ste 320 Charlotte NC 28207-1107
Phone: (704) 333-0741
Fax: (704) 333-3356
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 200200093 North Carolina
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 200200093 North Carolina

Profile Details

NPI number 1043201361
LBN Legal business name Burgess, Jason Shade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 4th, 2005
Last updated Sep 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043201361 NPPES
Other 2000396D MEDICARE PIN FACULTY
MEDICAID 891305A MEDICARE PIN FACULTY
Other 2000396 MEDICARE PIN FACULTY

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