Provider Demographics
NPI:1114985371
Name:AZIE, WILLIAM NDEKOUM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NDEKOUM
Last Name:AZIE
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 1:5801 BREMO RD
Mailing Address - Street 2:ATTENTION SARA WASKIN/ CVEA
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1907
Mailing Address - Country:US
Mailing Address - Phone:804-287-7066
Mailing Address - Fax:804-673-9531
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:ST MARY'S HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-287-7066
Practice Address - Fax:804-673-9531
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234970207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010018358Medicaid
H53203Medicare UPIN
VA002641C77Medicare ID - Type Unspecified