Healthcare Provider Details

I. General information

NPI: 1528012234
Provider Name (Legal Business Name): IAN FRANCIS WOOLLETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

IV. Provider business mailing address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

V. Phone/Fax

Practice location:
  • Phone: 757-282-4150
  • Fax: 757-510-9455
Mailing address:
  • Phone: 757-282-4150
  • Fax: 757-510-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0101238945
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101238945
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: