Provider Demographics
NPI:1467642603
Name:STANDAGE, STEPHEN WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WADE
Last Name:STANDAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE # MLC2005
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4259
Mailing Address - Fax:513-636-4267
Practice Address - Street 1:3333 BURNET AVE # MLC2005
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4259
Practice Address - Fax:513-636-4267
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431993208000000X
OH35.091392208000000X, 2080P0203X
WA602172392080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics