Individual
DR. WENDELL T POULSEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5659 PARKWAY DR, STE 100, GLOUCESTER, VA 23061-3792
(804) 210-1005
(804) 210-1009
Mailing address
5659 PARKWAY DR, STE 100, GLOUCESTER, VA 23061-3792
(804) 210-1005
(804) 210-1009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101031371
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010156041
—
VA
Enumeration date
02/21/2006
Last updated
01/11/2012
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