Provider Demographics
NPI:1467539676
Name:WADE, JUSTIN G (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:G
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8614 OCEAN GTWY
Mailing Address - Street 2:STE 4
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7217
Mailing Address - Country:US
Mailing Address - Phone:410-690-8181
Mailing Address - Fax:410-690-8185
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00665692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550002Medicaid
MD259147-000OtherMAGELLAN
MD346646OtherMHN
MDLM49EAOtherCAREFIRST BCBS
MD609550004Medicaid
MD517251OtherUBH
MD522156095OtherCOMMERCIAL INSURANCE
MDR968OtherCAREFIRST BCBS-FEDERAL
MD609550001Medicaid
MDR968OtherCAREFIRST BCBS-FEDERAL