Provider Demographics
NPI:1609962810
Name:WELLS, VIRGINIA DENISE (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DENISE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GOOCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-221-4386
Mailing Address - Fax:757-221-1245
Practice Address - Street 1:230 GOOCH DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-221-4386
Practice Address - Fax:757-221-1245
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110007739Medicare ID - Type Unspecified
VAB09993Medicare UPIN