Provider Demographics
NPI:1083692917
Name:ZHU, WYLIE H (MD)
Entity Type:Individual
Prefix:
First Name:WYLIE
Middle Name:H
Last Name:ZHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RIVERVIEW AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9140
Mailing Address - Fax:757-793-4149
Practice Address - Street 1:301 RIVERVIEW AVE STE 202A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9140
Practice Address - Fax:757-793-4149
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46914207T00000X
VA0101255217207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46914OtherMN MEDICAL LICENSE
MN46914OtherMN MEDICAL LICENSE