Individual
JASON SHADE BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1918 RANDOLPH RD STE 300, CHARLOTTE, NC 28207-1112
(704) 333-0741
(704) 333-3356
Mailing address
PO BOX 604350, CHARLOTTE, NC 28260-4350
(704) 364-8100
(704) 365-2073
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
200200093
NC
2086S0129X
Vascular Surgery Physician
200200093
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000396
MEDICARE
—
01
—
2000396D
MEDICARE PIN FACULTY
—
05
—
891305A
—
NC
Enumeration date
11/04/2005
Last updated
11/05/2025
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