Provider Demographics
NPI:1518941137
Name:MAKDISI, WALID F (MD)
Entity Type:Individual
Prefix:
First Name:WALID
Middle Name:F
Last Name:MAKDISI
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 1:112 GAINSBOROUGH SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1706
Mailing Address - Country:US
Mailing Address - Phone:757-547-0798
Mailing Address - Fax:757-547-0145
Practice Address - Street 1:112 GAINSBOROUGH SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1706
Practice Address - Country:US
Practice Address - Phone:757-547-0798
Practice Address - Fax:757-547-0145
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236763207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3127717OtherUNITEDHEALTHCHARE
VA010115469Medicaid
VA3127717OtherMAMSI/MDIPA
VA79947OtherSENTARA/OPTIMA
VAP00194039OtherMEDICARE RAILROAD
VA00W183T06Medicare ID - Type Unspecified
VA010115469Medicaid