Provider Demographics
NPI:1467482984
Name:ILYAS, WAQAS (MD)
Entity type:Individual
Prefix:
First Name:WAQAS
Middle Name:
Last Name:ILYAS
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 1:347 WESTSIDE STATION DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2840
Mailing Address - Country:US
Mailing Address - Phone:540-662-1810
Mailing Address - Fax:540-662-1812
Practice Address - Street 1:347 WESTSIDE STATION DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2840
Practice Address - Country:US
Practice Address - Phone:540-662-1810
Practice Address - Fax:540-662-1812
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062263A207W00000X
VA0101236475207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467482984Medicaid
VAP00717921OtherMEDICARE RR
WV3810014188Medicaid
VASC0001147Medicare PIN