Provider Demographics
NPI:1134605652
Name:WADE, DANA PARIS (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:PARIS
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NOEL
Other - Middle Name:
Other - Last Name:KAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 LAFAYETTE BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4710
Mailing Address - Country:US
Mailing Address - Phone:203-683-5946
Mailing Address - Fax:
Practice Address - Street 1:1000 LAFAYETTE BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4710
Practice Address - Country:US
Practice Address - Phone:203-683-5946
Practice Address - Fax:203-683-5901
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator