MEDICARE: ELIZABETH ANNE WADE M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	2019018370	MO
2	2084P0804X	Child & Adolescent Psychiatry Physician	191641	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457500480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE WADE M. D.

Provider Business Mailing Address
First Line	:	PO BOX 1307
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-1307
Country	:	US
Telephone Number	:	845-226-5735
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 LONGVIEW AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2317
Country	:	US
Telephone Number	:	845-226-5735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	10/22/2019

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