Provider Demographics
NPI:1518966928
Name:GRAINGER, WADE K (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:K
Last Name:GRAINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-6282
Mailing Address - Fax:828-687-6285
Practice Address - Street 1:1998 HENDERSONVILLE RD SKYLAND OFFICE PARK
Practice Address - Street 2:SUITE 45
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-684-2008
Practice Address - Fax:828-687-8329
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36702OtherBCBS
NC8936702Medicaid
NC8936702Medicaid
C84142Medicare UPIN