Provider Demographics
NPI:1225145477
Name:ABINGDON EAR NOSE & THROAT ASSOCIATES PC
Entity Type:Organization
Organization Name:ABINGDON EAR NOSE & THROAT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-628-9547
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1328
Mailing Address - Country:US
Mailing Address - Phone:276-628-9547
Mailing Address - Fax:276-628-8221
Practice Address - Street 1:176 VALLEY ST NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2836
Practice Address - Country:US
Practice Address - Phone:276-628-9547
Practice Address - Fax:276-628-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA067757OtherBC/BS VA
VAC01909Medicare PIN