Provider Demographics
NPI:1578593604
Name:WADE, JULIE MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MELISSA
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:185 TILLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SO BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4484
Mailing Address - Country:US
Mailing Address - Phone:802-862-7338
Mailing Address - Fax:802-862-8411
Practice Address - Street 1:185 TILLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4484
Practice Address - Country:US
Practice Address - Phone:802-862-7338
Practice Address - Fax:802-862-8411
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011126207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012673Medicaid