MEDICARE: DOUGLAS C WAITE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036071	CT
2	207R00000X	Internal Medicine Physician	73862	MA
3	207RI0200X	Infectious Disease Physician	036071	CT
4	207RI0200X	Infectious Disease Physician	73862	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386641025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS C WAITE MD

Provider Business Mailing Address
First Line	:	123 SUMMER STREET
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	06108-1216
Country	:	US
Telephone Number	:	508-363-5000
Fax Number	:	508-363-7551

Provider Business Practice Location Address
First Line	:	123 SUMMER ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1216
Country	:	US
Telephone Number	:	508-363-5000
Fax Number	:	508-363-7551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/18/2014

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Directions to “ DOUGLAS C WAITE MD” Practice Location

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