Provider Demographics
NPI:1164495792
Name:WERWATH, DAVID LEE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WERWATH
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 1:3198 PACIFIC AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2949
Mailing Address - Country:US
Mailing Address - Phone:757-428-1911
Mailing Address - Fax:
Practice Address - Street 1:3198 PACIFIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-2949
Practice Address - Country:US
Practice Address - Phone:757-428-1911
Practice Address - Fax:757-428-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034422207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010007640Medicaid
465954OtherBCBS VA
465954OtherBCBS FEP
159097XXOtherPREFERRED CARE
465954OtherBS OUT OF STATE
40935OtherSENTARA OPTIMA
465954OtherBS OUT OF STATE
465954OtherBCBS FEP
159097XXOtherPREFERRED CARE