Provider Demographics
NPI:1184820003
Name:WADE, CHARLES SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SETH
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:SETH
Other - Last Name:EISENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Mailing Address - Street 2:620 JOHN PAUL JONES CIR
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704
Mailing Address - Country:US
Mailing Address - Phone:757-953-1276
Mailing Address - Fax:
Practice Address - Street 1:NMCP CARDIOLOGY
Practice Address - Street 2:620 JOHN PAUL JONES CIR
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704
Practice Address - Country:US
Practice Address - Phone:757-953-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066642A207R00000X
390200000X
VA0101267882207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184820003Medicaid