Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101049021 | VA |
NPI | 1003833757 |
---|---|
Provider Name | Michele Wadsworth |
First Address | Virginia Beach, VA 23456-3908 |
Second Address | Virginia Beach, VA 23456-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
237158 | ANTHEM BCBS,HK,HK+,FAMIS (01) | VA |
35381 | OPTIMA,FAMILY CARE,FAMIS (01) | VA |
541778786 | NC HEALTH CH (01) | NC |
5417787860686E | CIGNA (01) | VA |
637669 | ALLIANCE,MAMSI,MDIPA, (01) | VA |
6739784 | (05) | VA |
890618K | (05) | NC |
G09733 | (02) | VA |