Provider Demographics
NPI:1720434830
Name:MENENDEZ, WADE HOWARD
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:HOWARD
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7694 DORCHESTER BLVD APT 210
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2070
Mailing Address - Country:US
Mailing Address - Phone:443-254-2563
Mailing Address - Fax:
Practice Address - Street 1:7452 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3547
Practice Address - Country:US
Practice Address - Phone:410-553-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management