Individual
RAYMOND C WADLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031
(571) 472-1180
(571) 472-1197
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(714) 235-6985
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101248821
VA
207RH0003X
Hematology & Oncology Physician
Primary
0101248821
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548370612
—
VA
Enumeration date
08/30/2006
Last updated
02/28/2022
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