Individual
WADE H MARION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
MEDICAL CENTER BOULEVARD, WINSTON-SALEM, NC 27157
(336) 716-6192
(336) 716-4318
Mailing address
MEDICAL CENTER BOULEVARD, WINSTON-SALEM, NC 27157
(336) 716-6192
(336) 716-4318
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
101159
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1608PA
SC MEDICAID
NC
01
—
1659357176
VIRGINIA MEDICAID
NC
05
—
1659357176
—
NC
01
—
2469136
UNITED HEALTHCARE
NC
01
—
7010743
AETNA
—
01
—
D5133
MEDCOST
NC
Enumeration date
12/16/2005
Last updated
11/22/2013
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