Provider Demographics
NPI:1861243149
Name:WADE, RAYMOND KENNETH
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:KENNETH
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 1:932 CYPRESS POINT CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2304
Mailing Address - Country:US
Mailing Address - Phone:301-471-3681
Mailing Address - Fax:
Practice Address - Street 1:5812 8TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2712
Practice Address - Country:US
Practice Address - Phone:202-269-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant