Provider Demographics
NPI:1184745234
Name:WADE, MARCIA J (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:J
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SUTTON PL S
Mailing Address - Street 2:SOUTH 19 C-N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4168
Mailing Address - Country:US
Mailing Address - Phone:212-421-8409
Mailing Address - Fax:
Practice Address - Street 1:60 SUTTON PL S
Practice Address - Street 2:SOUTH 19 C-N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4168
Practice Address - Country:US
Practice Address - Phone:212-421-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47673207RP1001X
NY138658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease