Provider Demographics
NPI:1770699837
Name:MCENTIRE, WESLEY E (MD)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:E
Last Name:MCENTIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2002 BREMO ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2441
Mailing Address - Country:US
Mailing Address - Phone:804-285-0401
Mailing Address - Fax:804-285-0405
Practice Address - Street 1:2002 BREMO ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2441
Practice Address - Country:US
Practice Address - Phone:804-285-0401
Practice Address - Fax:804-285-0405
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010186632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
034452OtherANTHEM BC/BS
B08544Medicare UPIN