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NPI Code Detail

MEDICARE: THEODORE B. WADE PA-C

MEDICARE: THEODORE B. WADE PA-C
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
1363A00000XPhysician Assistant1429TN

General Provider Information

NPI Number : 1548260847
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE B. WADE PA-C
Provider Business Mailing Address
First Line : 2011 MURPHY AVE
Second Line : STE 301
City : NASHVILLE
State : TN
Zip : 37203-2023
Country : US
Telephone Number : 615-327-9543
Fax Number : 615-341-7583
Provider Business Practice Location Address
First Line : 2011 MURPHY AVE
Second Line : STE 301
City : NASHVILLE
State : TN
Zip : 37203-2023
Country : US
Telephone Number : 615-327-9543
Fax Number : 615-341-7583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 11/19/2014

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Directions to “ THEODORE B. WADE PA-C” Practice Location

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