Healthcare Provider Details

I. General information

NPI: 1487612248
Provider Name (Legal Business Name): KAREN E. WADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/07/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PEYTON STREET
WINCHESTER VA
22601-3935
US

IV. Provider business mailing address

130 PEYTON STREET
WINCHESTER VA
22601-3935
US

V. Phone/Fax

Practice location:
  • Phone: 540-678-1433
  • Fax: 540-678-1719
Mailing address:
  • Phone: 540-678-1433
  • Fax: 540-678-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101041215
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: