Provider Demographics
NPI:1750919130
Name:WADE DIAZ, MARY ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:WADE DIAZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:828 HEALTHY WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7960
Mailing Address - Country:US
Mailing Address - Phone:757-305-1797
Mailing Address - Fax:757-309-4715
Practice Address - Street 1:828 HEALTHY WAY STE 220
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7960
Practice Address - Country:US
Practice Address - Phone:757-305-1797
Practice Address - Fax:757-309-4715
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine