Provider Demographics
NPI:1306107024
Name:WAY, EWA (MD)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:M
Other - Last Name:WAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:1200 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5049
Practice Address - Country:US
Practice Address - Phone:804-828-2467
Practice Address - Fax:804-628-5854
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012619052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology