Provider Demographics
NPI:1245282284
Name:WIELAR, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WIELAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800778
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0778
Mailing Address - Country:US
Mailing Address - Phone:434-924-0000
Mailing Address - Fax:434-924-2078
Practice Address - Street 1:4100 OLYMPIA CIR STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3620
Practice Address - Country:US
Practice Address - Phone:434-220-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001138730207L00000X
NC174543367500000X
VA0024168704207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA100601Medicare UPIN
NC8052093Medicaid