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:
Health care specialties
| Specialty | Code | License # | 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 last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043201361 | NPPES |
| Other | 2000396D | MEDICARE PIN FACULTY | |
| MEDICAID | 891305A | MEDICARE PIN FACULTY | |
| Other | 2000396 | MEDICARE PIN FACULTY |
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