Provider Demographics
NPI:1831209550
Name:WU, DIEM N (MD)
Entity type:Individual
Prefix:
First Name:DIEM
Middle Name:N
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIEM
Other - Middle Name:B
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7813 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4210
Mailing Address - Country:US
Mailing Address - Phone:804-264-4545
Mailing Address - Fax:804-264-4545
Practice Address - Street 1:7813 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4210
Practice Address - Country:US
Practice Address - Phone:804-264-4545
Practice Address - Fax:804-264-4545
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500853207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901551Medicaid
NC5901551Medicaid
NCI38504Medicare UPIN