Provider Demographics
NPI:1841343126
Name:WING, JOHN E (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:WING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4564
Mailing Address - Country:US
Mailing Address - Phone:757-934-1003
Mailing Address - Fax:757-934-1660
Practice Address - Street 1:114 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4564
Practice Address - Country:US
Practice Address - Phone:757-934-1003
Practice Address - Fax:757-934-1660
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6068286Medicaid
NC890658EMedicaid
VA095436OtherANTHEM
VA6068286Medicaid
NC890658EMedicaid