Healthcare Provider Details

I. General information

NPI: 1598737462
Provider Name (Legal Business Name): BRENT DENMAN WAINWRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E SHORE RD
NEW PRESTON CT
06777-1628
US

IV. Provider business mailing address

18 E SHORE RD
NEW PRESTON CT
06777-1628
US

V. Phone/Fax

Practice location:
  • Phone: 484-868-9998
  • Fax: 860-393-1079
Mailing address:
  • Phone: 484-868-9998
  • Fax: 860-393-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number234018
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number43818
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: