Healthcare Provider Details

I. General information

NPI: 1609222967
Provider Name (Legal Business Name): WAYNE TSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 305
SUFFOLK VA
23434-8158
US

IV. Provider business mailing address

1250 E. MARSHALL ST. BOX 980135
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4222
  • Fax: 757-934-4111
Mailing address:
  • Phone: 804-828-7391
  • Fax: 804-828-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24433
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: