Healthcare Provider Details

I. General information

NPI: 1548256266
Provider Name (Legal Business Name): EUGENE HENRY PETER WADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 NC HWY 66 SOUTH SUITE 210
KERNERSVILLE NC
27284
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-992-1770
  • Fax: 336-992-1776
Mailing address:
  • Phone: 336-992-1770
  • Fax: 336-992-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28368
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: