Provider Demographics
NPI:1942296652
Name:WADE, JAMES MERON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MERON
Last Name:WADE
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 1:14460 WHITE TOP VW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-7750
Mailing Address - Country:US
Mailing Address - Phone:276-628-8398
Mailing Address - Fax:
Practice Address - Street 1:176 VALLEY ST NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2836
Practice Address - Country:US
Practice Address - Phone:276-628-9547
Practice Address - Fax:276-628-8221
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029419207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006578268Medicaid
VA014656OtherANTHEM
B10020Medicare UPIN
VA040000082Medicare ID - Type Unspecified