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General NPI Number Information
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NPI Number | 1407952419
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Entity Type | Individual
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Provider Name | VIRGINIA D. WADE M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 1060 5TH AVE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10128-0104
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Country | US
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Telephone | 212-348-4994
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Fax | 212-348-4996
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Provider Business Mailing Address
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Address Line | 1060 5TH AVE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10128-0104
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Country | US
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Telephone | 212-348-4994
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Fax | 212-348-4996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 155086
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 040106
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License Number State | CT
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