Basic Information
| Provider Information | |||||||||
| NPI: | 1528012234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOLLETT | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 CLEVELAND ST | ||||||||
| Address2: | SUITE 228 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234621752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574992825 | ||||||||
| FaxNumber: | 7574994248 | ||||||||
| Practice Location | |||||||||
| Address1: | 612 KINGSBOROUGH SQ | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575479294 | ||||||||
| FaxNumber: | 7575480092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101238945 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 0101238945 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 10003534 | 01 | VA | OPTIMA/SENTARA | OTHER | PAR | 01 | VA | CIGNA | OTHER | 010245303 | 05 | VA | MEDICAID | 067VT | 01 | NC | BCBS | OTHER | 247031 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | AETNA | OTHER | -001 | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 189010 | 01 | VA | ANTHEM BCBS | OTHER | 3144142 | 01 | VA | UHC/MAMSI | OTHER | 03363 | 01 | NC | BC/BS | OTHER | 1528012234 | 05 | VA | MEDICAID | 5903363 | 05 | NC | MEDICAID | 10013938 | 01 | VA | SENTARA OPTIMA | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER |