Provider Demographics
NPI:1992811962
Name:BURGERT, JESSICA WRIGHT (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:WRIGHT
Last Name:BURGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARGARET
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:1411 GREENWAY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6954
Practice Address - Country:US
Practice Address - Phone:919-292-1878
Practice Address - Fax:919-292-1879
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301311207Q00000X
NC2003013111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913621Medicaid
NC2073203Medicare PIN