Provider Demographics
NPI:1144388448
Name:WADE, ALISHA NICOLE (MBBS, DPHIL)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:NICOLE
Last Name:WADE
Suffix:
Gender:F
Credentials:MBBS, DPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POSTNET SUITE 70
Mailing Address - Street 2:PRIVATE BAG X9
Mailing Address - City:BENMORE
Mailing Address - State:GAUTENG
Mailing Address - Zip Code:2010
Mailing Address - Country:ZA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WITS DONALD GORDON MEDICAL CENTRE
Practice Address - Street 2:18 ETON ROAD
Practice Address - City:PARKTOWN
Practice Address - State:GAUTENG
Practice Address - Zip Code:2193
Practice Address - Country:ZA
Practice Address - Phone:011-356-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ0207R00000X
ZZMP0694819207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism