Provider Demographics
NPI:1699759159
Name:YOUNG, WADE EARLE (MD)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:EARLE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:60 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1908
Mailing Address - Country:US
Mailing Address - Phone:419-448-8811
Mailing Address - Fax:419-448-7418
Practice Address - Street 1:60 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1908
Practice Address - Country:US
Practice Address - Phone:419-448-8811
Practice Address - Fax:419-448-7418
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35050815207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0569040Medicaid
OH2742787Medicaid
OHA17436Medicare UPIN
OH2742787Medicaid