Provider Demographics
NPI:1144100157
Name:WADE, MALIK TRAYVON
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:TRAYVON
Last Name:WADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 CALL PL SE APT B1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6209
Mailing Address - Country:US
Mailing Address - Phone:771-777-0042
Mailing Address - Fax:
Practice Address - Street 1:4950 CALL PL SE APT B1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6209
Practice Address - Country:US
Practice Address - Phone:771-777-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty