Provider Demographics
NPI:1942232079
Name:WAMPLER, GUY BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:BENJAMIN
Last Name:WAMPLER
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 1:8650 SUDLEY RD
Mailing Address - Street 2:#206
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-368-9234
Mailing Address - Fax:703-368-0505
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:#206
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-368-9234
Practice Address - Fax:703-368-0505
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010461032086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA094369OtherANTHEM BCBS
VA007365233Medicaid
VA094369OtherANTHEM BCBS
VA007365233Medicaid