Michele Wadsworth, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101049021 Issued in VA

Practice address

2117 McComas Way
Ste. 103
Virginia Beach, VA 23456-3908

Phone

(757) 668-6715

Fax

(757) 668-6680

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Medical Group Inc

  • Pediatrics Physician
  • Virginia Beach, VA
  • NPI 1366597114
  NPD (past)
• Childrens Specialty Group PLLC

  • Pediatrics Physician
  • Norfolk, VA
  • NPI 1255354130
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003833757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 MCCOMAS WAY",
            "address_2": "STE. 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234563908",
            "telephone_number": "757-668-6715",
            "fax_number": "757-668-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 MCCOMAS WAY",
            "address_2": "STE. 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234563908",
            "telephone_number": "757-668-6715",
            "fax_number": "757-668-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADSWORTH",
        "first_name": "MICHELE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101049021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5417787860686E",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890618K",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS,HK,HK,FAMIS",
            "identifier": "237158",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE,MAMSI,MDIPA,",
            "identifier": "637669",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC HEALTH CH",
            "identifier": "541778786",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6739784",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA,FAMILY CARE,FAMIS",
            "identifier": "35381",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Elizabeth Wade Diaz, DO
• Carol Jutras Wade, CRNA
• Crystal Lynn Wade
• Heather Ann Wade
• Ronda Wade
• Tyler Michelle Waggoner
• Brendan Matthias Wagner, RBT
• Deyounga Wagner
• Grace Wagner
• Jane Annette Wagner

• Pediatrics Physician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.