Provider Demographics
NPI:1588234710
Name:WADE, MADISON B
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:B
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 SCHOOLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3034
Mailing Address - Country:US
Mailing Address - Phone:330-389-8776
Mailing Address - Fax:
Practice Address - Street 1:6460 SCHOOLVIEW DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3034
Practice Address - Country:US
Practice Address - Phone:330-389-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health