Healthcare Provider Details

I. General information

NPI: 1366496804
Provider Name (Legal Business Name): WAYNE ANDRADE HENRY SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

IV. Provider business mailing address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1561
  • Fax: 207-626-1849
Mailing address:
  • Phone: 207-626-1561
  • Fax: 207-626-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011016-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberEC201008
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: