Marvin Scott Wade, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2091 Issued in SC

Practice address

9267 Medical Plaza Dr
North Charleston, SC 29406-9139

Phone

(843) 797-3636

NPI assigned

Nov 8, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1477534469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9267 MEDICAL PLAZA DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069139",
            "telephone_number": "843-797-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9267 MEDICAL PLAZA DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069139",
            "telephone_number": "843-797-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "MARVIN",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1057840",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vitality Medical Centers of Charleston Inc
• Daryl Voce
• Christopher James Von Bargen
• Sabrina Elizabeth Von Bargen, DDS
• Mekensi Deigh Voss, LPC-A, ADC-IP
• Wade'S Sitting and Care LLC
• Audra Wagaman, PSYD
• Linda M Wagner, LMSW
• Martha Laine Wagoner, FNP
• Amanda Michelle Waite, RN

• Physician Assistant in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.