Provider Demographics
NPI:1306910476
Name:WADE, LARREN (MD)
Entity type:Individual
Prefix:
First Name:LARREN
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5194 DAWES AVE
Mailing Address - Street 2:LARREN WADE MD INTERNAL MEDICINE
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311
Mailing Address - Country:US
Mailing Address - Phone:703-671-9530
Mailing Address - Fax:703-671-0331
Practice Address - Street 1:5194 DAWES AVE
Practice Address - Street 2:LARREN WADE MD INTERNAL MEDICINE
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311
Practice Address - Country:US
Practice Address - Phone:703-671-9530
Practice Address - Fax:703-671-0331
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10005Medicare UPIN