Healthcare Provider Details

I. General information

NPI: 1710941505
Provider Name (Legal Business Name): JAMES WASSUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE WRIGHT DR
NORFOLK VA
23502-1871
US

IV. Provider business mailing address

26 JACOBS LANE
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-213-5770
  • Fax: 757-213-5789
Mailing address:
  • Phone: 757-870-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101024227
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: