Provider Demographics
NPI:1053320572
Name:WADE, MELVIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:D
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3437
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-0437
Mailing Address - Country:US
Mailing Address - Phone:503-269-9435
Mailing Address - Fax:503-385-8554
Practice Address - Street 1:2525 12TH ST SE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2153
Practice Address - Country:US
Practice Address - Phone:503-364-3704
Practice Address - Fax:503-399-9722
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14645207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500762075Medicaid
ORP00117971OtherRR MEDICARE
WA1040088Medicaid
OR176172Medicaid
OR176172Medicaid