Provider Demographics
NPI:1285488775
Name:WISE, MADALINA (MD)
Entity type:Individual
Prefix:
First Name:MADALINA
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADALINA
Other - Middle Name:
Other - Last Name:MIRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 J. CLYDE MORRIS BLVD.
Mailing Address - Street 2:DEPT. OF MEDICAL EDUCATION/ANNEX: SECOND FLOOR
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601
Mailing Address - Country:US
Mailing Address - Phone:757-612-7277
Mailing Address - Fax:757-594-3184
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-612-7277
Practice Address - Fax:757-594-3184
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program