Provider Demographics
NPI:1548256266
Name:WADE, EUGENE HENRY PETER (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:HENRY PETER
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-992-1770
Mailing Address - Fax:336-992-1776
Practice Address - Street 1:1635 NC HWY 66 SOUTH
Practice Address - Street 2:SUITE 210
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-992-1770
Practice Address - Fax:336-992-1776
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine