MEDICARE: DR. DAVID WADDELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101042669	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710996491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WADDELL M.D.

Provider Business Mailing Address
First Line	:	1856 COLONIAL MEDICAL CT
Second Line	:	SUITE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3075
Country	:	US
Telephone Number	:	757-962-6262
Fax Number	:	757-962-1185

Provider Business Practice Location Address
First Line	:	1856 COLONIAL MEDICAL CT
Second Line	:	SUITE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3075
Country	:	US
Telephone Number	:	757-962-6262
Fax Number	:	757-962-1185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	12/13/2010

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