Individual
CHARLES E. WADSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
9101 STONY POINT DR, RICHMOND, VA 23235
(804) 330-9105
(804) 287-6119
Mailing address
9101 STONY POINT DR, RICHMOND, VA 23235
(804) 330-9105
(804) 287-6119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110 840588
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010187974
—
VA
01
—
541203530
TAX IDENTIFICATION NUMBER
VA
Enumeration date
04/25/2006
Last updated
10/28/2020
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