Provider Demographics
NPI:1528012234
Name:WOOLLETT, IAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:F
Last Name:WOOLLETT
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 1:5700 CLEVELAND ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1752
Mailing Address - Country:US
Mailing Address - Phone:757-499-2825
Mailing Address - Fax:757-499-4248
Practice Address - Street 1:612 KINGSBOROUGH SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4986
Practice Address - Country:US
Practice Address - Phone:757-547-9294
Practice Address - Fax:757-548-0092
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238945207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCORVEL/CORCARE
VA10003534OtherOPTIMA/SENTARA
VAPAROtherCIGNA
VA010245303Medicaid
NC067VTOtherBCBS
VA247031OtherANTHEM
VAPAROtherAETNA
VA-001OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA189010OtherANTHEM BCBS
VA3144142OtherUHC/MAMSI
NC03363OtherBC/BS
VA1528012234Medicaid
NC5903363Medicaid
VA10013938OtherSENTARA OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAP00374206Medicare PIN
VA011670E30Medicare PIN
VAPAROtherAETNA
VA3144142OtherUHC/MAMSI
VAPAROtherCIGNA