Provider Demographics
NPI:1427115369
Name:WADE, TIMOTHY VINCENT (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:VINCENT
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 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-475-8501
Mailing Address - Fax:360-744-6561
Practice Address - Street 1:2520 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4229
Practice Address - Country:US
Practice Address - Phone:360-475-8501
Practice Address - Fax:360-744-6561
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08734200207ZP0102X
PAMD436170207ZP0102X
WAMD60280473207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1427115369OtherHORIZON NJ HEALTH
NJ3790594000OtherAMERHEALTH NJ
NJ0230421Medicaid
NJ186818Medicare PIN