Provider Demographics
NPI:1760431613
Name:NAZIRI, WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:
Last Name:NAZIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WADE
Other - Middle Name:
Other - Last Name:NAZIRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2455 EMERALD PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5785
Mailing Address - Country:US
Mailing Address - Phone:252-758-2224
Mailing Address - Fax:252-758-2860
Practice Address - Street 1:2455 EMERALD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5785
Practice Address - Country:US
Practice Address - Phone:252-758-2224
Practice Address - Fax:252-758-2860
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701079208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10598OtherBCBS NUMBER
NC8910598Medicaid
NC10598OtherBCBS NUMBER
NCF03170Medicare UPIN