Provider Demographics
NPI:1144252289
Name:GOOLISHIAN, WADE THOMAS (MD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:THOMAS
Last Name:GOOLISHIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3127
Mailing Address - Country:US
Mailing Address - Phone:508-775-5011
Mailing Address - Fax:508-775-4754
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:CAPE COD HOSPITAL ANESTHESIA DEPT
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-771-1800
Practice Address - Fax:508-790-4674
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA70330207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3092313Medicaid
F26096Medicare UPIN
MA3092313Medicaid