Individual
JONATHAN HILL BURDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
9700877
NC
2085R0204X
Vascular & Interventional Radiology Physician
9700877
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1068X
BCBS
—
05
—
2002308000
—
WV
01
—
25354
PARTNERS
—
01
—
5548719
AETNA
—
05
—
7222629
—
VA
01
—
81894
MEDCOST
—
05
—
891068X
—
NC
05
—
Q00878
—
SC
Enumeration date
12/08/2005
Last updated
10/08/2010
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