Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 0101037527 | VA |
N | 2086X0206X | Surgical Oncologist | H5645 | TX |
NPI | 1407828387 |
---|---|
Provider Name | Dr. David S. Wade |
First Address | Washington, DC 20535-0001 |
Second Address | Washington, DC 20535-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 11/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |