Individual
WAYNE D OLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 KINGSBOROUGH SQ, SUITE 100, CHESAPEAKE, VA 23320-5041
(757) 547-9294
(757) 213-9374
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3508
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
0101035591
VA
207RC0000X
Cardiovascular Disease Physician
0101035590
VA
207RI0011X
Interventional Cardiology Physician
0101035590
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-001
CHAMPUS/TRICARE
VA
05
—
006010393
—
VA
05
—
006059066
—
VA
01
—
0570R
BC/BS NC
NC
01
—
15071
OPTIMA/SENTARA
VA
01
—
250366
ATHEM BC/BS VA/HK
VA
01
—
259544
ANTHEM BCBS
VA
01
—
263654
UHC/MAMSI/MDIPA
VA
01
—
75288
SENTARA OHP/SHP
VA
05
—
890570R
—
NC
01
—
PAR
VHN/PHCS
VA
Enumeration date
02/27/2006
Last updated
05/03/2018
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