Provider Demographics
NPI:1114027612
Name:GEBARA, WADE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:JOSEPH
Last Name:GEBARA
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 1:149 OBLONG RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-3038
Mailing Address - Country:US
Mailing Address - Phone:413-458-9975
Mailing Address - Fax:
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2092182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA01813203Medicaid
VT1007786OtherVERMONT HEALTH ACCESS
VT1007786Medicaid
MA9714677OtherMASS HEALTH PROVIDER
MA000000023752OtherMASS HEALTH NET PROVIDER
MAG67009Medicare UPIN
MABB0443Medicare ID - Type Unspecified