Healthcare Provider Details

I. General information

NPI: 1881732386
Provider Name (Legal Business Name): WAYNE DILLARD, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ERDMAN WAY STE 309
LEOMINSTER MA
01453-1818
US

IV. Provider business mailing address

PO BOX 639
SACO ME
04072-0639
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-6265
  • Fax:
Mailing address:
  • Phone: 978-534-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number60425
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number60425
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number60425
License Number StateMA

VIII. Authorized Official

Name: WAYNE DILLARD
Title or Position: OWNER
Credential: D.O.
Phone: 978-534-6265