Healthcare Provider Details

I. General information

NPI: 1770926701
Provider Name (Legal Business Name): CHENG-CHIA WU MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

9568 KINGS CHARTER DR STE 202
ASHLAND VA
23005-7955
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-0606
  • Fax:
Mailing address:
  • Phone: 42-668-7178
  • Fax: 804-266-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101283484
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number294890-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: