Provider Demographics
NPI:1487612248
Name:WADE, KAREN E (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PEYTON STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3935
Mailing Address - Country:US
Mailing Address - Phone:540-678-1433
Mailing Address - Fax:540-678-1719
Practice Address - Street 1:130 PEYTON STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3935
Practice Address - Country:US
Practice Address - Phone:540-678-1433
Practice Address - Fax:540-678-1719
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006207171Medicaid
WV3810003930Medicaid
VA006207171Medicaid
VA160001036Medicare ID - Type Unspecified