Provider Demographics
NPI:1043284763
Name:BROSIUS, WADE A (DO)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:A
Last Name:BROSIUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3241
Mailing Address - Country:US
Mailing Address - Phone:610-327-4200
Mailing Address - Fax:610-327-8160
Practice Address - Street 1:307 S LEWIS RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1828
Practice Address - Country:US
Practice Address - Phone:610-792-0300
Practice Address - Fax:610-792-3790
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008179L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05727Medicare UPIN
80177130Medicare PIN
776445Medicare ID - Type Unspecified