1730224304 NPI number — DR. MICHELE DOREEN BURGET M.D.

Table of content: DR. MICHELE DOREEN BURGET M.D. (NPI 1730224304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730224304 NPI number — DR. MICHELE DOREEN BURGET M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGET
Provider First Name:
MICHELE
Provider Middle Name:
DOREEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730224304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1583 STANDING RIDGE DR STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWHATAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23139-8051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-375-1589
Provider Business Mailing Address Fax Number:
804-325-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1583 STANDING RIDGE DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWHATAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23139-8051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-375-1589
Provider Business Practice Location Address Fax Number:
804-325-1190
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  0101232551 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 289596 . This is a "ANTHEM PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541381483 . This is a "TAX ID #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010030498 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10012164 . This is a "OPTIMA PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7778179 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010030498 . This is a "VIRGINIA PREMIER PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8114312 . This is a "MAMSI ALLIANCE PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000241787301 . This is a "UNITED HEALTHCARE PROV#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7447576 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 778179 . This is a "SOUTHERN HEALTH PROV#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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