Healthcare Provider Details

I. General information

NPI: 1376643254
Provider Name (Legal Business Name): WADE R CARTWRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 30TH ST # 401
OAKLAND CA
94609-3301
US

IV. Provider business mailing address

411 30TH ST # 401
OAKLAND CA
94609-3301
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-6642
  • Fax: 510-834-3115
Mailing address:
  • Phone: 510-834-6642
  • Fax: 510-834-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG262211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: