Healthcare Provider Details

I. General information

NPI: 1891035416
Provider Name (Legal Business Name): DONALD F WADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 VASSAR DR
CHARLESTON SC
29407-4236
US

IV. Provider business mailing address

1728 VASSAR DR
CHARLESTON SC
29407-4236
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-3502
  • Fax: 843-766-3502
Mailing address:
  • Phone: 843-766-3502
  • Fax: 843-766-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number5860
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: