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General NPI Number Information
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NPI Number | 1467539676
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Entity Type | Individual
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Provider Name | JUSTIN G WADE MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/28/2017
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Provider Practice Location Address
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Address Line | 29520 CANVASBACK DR
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City | EASTON
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State | MD
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Zip | 21601-7124
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Country | US
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Telephone | 410-822-5007
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Fax | 410-822-5569
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Provider Business Mailing Address
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Address Line | 8614 OCEAN GTWY STE 4
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City | EASTON
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State | MD
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Zip | 21601-7217
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Country | US
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Telephone | 410-690-8181
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Fax | 410-690-8185
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | D0066569
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License Number State | MD
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