Provider Demographics
NPI:1174574685
Name:WADE, JAMES C (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:1000 EAST MOUNTAIN BLVD.
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-3486
Practice Address - Country:US
Practice Address - Phone:570-808-6150
Practice Address - Fax:570-808-6174
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44131207RX0202X
PAMD446909207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34162000Medicaid
003000261KOtherHUMANA
PA102762237Medicaid
D73886Medicare UPIN
PA102762237Medicaid