Healthcare Provider Details

I. General information

NPI: 1124027305
Provider Name (Legal Business Name): DAREN MURRAY WINGARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 SOUTH BLVD STE 200
VIRGINIA BEACH VA
23452-1160
US

IV. Provider business mailing address

PO BOX 2546
VIRGINIA BEACH VA
23450-2546
US

V. Phone/Fax

Practice location:
  • Phone: 757-340-2864
  • Fax: 757-340-4278
Mailing address:
  • Phone: 757-340-3489
  • Fax: 757-340-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101054459
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101054459
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: