Provider Demographics
NPI:1306214341
Name:WADE, MADELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:MADELAINE
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADELAINE
Other - Middle Name:
Other - Last Name:SCHAUFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1500 SOUTH MAIN STREET
Mailing Address - Street 2:JPS FAMILY MEDICINE DEPARTMENT
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3785
Mailing Address - Country:US
Mailing Address - Phone:682-207-4495
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-702-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006645133V00000X
TX390200000X
TXV4774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program