Provider Demographics
NPI:1689670283
Name:MAGEE, WILLIAM PRESTON JR (DDS, MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PRESTON
Last Name:MAGEE
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 W BRAMBLETON AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1115
Mailing Address - Country:US
Mailing Address - Phone:757-627-6700
Mailing Address - Fax:757-627-8973
Practice Address - Street 1:400 W BRAMBLETON AVE
Practice Address - Street 2:STE 103
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1115
Practice Address - Country:US
Practice Address - Phone:757-627-6700
Practice Address - Fax:757-627-8973
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025282208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA118086OtherANTHEM
4004746OtherAETNA
VA600214778OtherCIGNA
VA15233OtherOPTIMA
NC006906200Medicaid
VA6901425Medicaid
310853OtherMAMSI
VA6901425Medicaid
310853OtherMAMSI