Provider Demographics
NPI:1023018140
Name:WYNE, AMJAD UZAIR (MD)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:UZAIR
Last Name:WYNE
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 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-731-3172
Mailing Address - Fax:
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032481207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010116473Medicaid
VACF9878OtherRR MEDICARE GROUP
VACF9878OtherRR MEDICARE GROUP
VA005985C55Medicare PIN
VA5816696Medicare ID - Type Unspecified
VAB05913Medicare UPIN