1285488775 NPI number — MADALINA WISE MD

Table of content: MADALINA WISE MD (NPI 1285488775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285488775 NPI number — MADALINA WISE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISE
Provider First Name:
MADALINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRON
Provider Other First Name:
MADALINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285488775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 J. CLYDE MORRIS BLVD.
Provider Second Line Business Mailing Address:
DEPT. OF MEDICAL EDUCATION/ANNEX: SECOND FLOOR
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-612-7277
Provider Business Mailing Address Fax Number:
757-594-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 J CLYDE MORRIS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23601-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-612-7277
Provider Business Practice Location Address Fax Number:
757-594-3184
Provider Enumeration Date:
04/12/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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