Healthcare Provider Details

I. General information

NPI: 1699760488
Provider Name (Legal Business Name): WAYNE WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEALTHCARE DR
BIDDEFORD ME
04005-9449
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-4270
  • Fax: 207-282-7350
Mailing address:
  • Phone: 207-282-4270
  • Fax: 207-282-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD20444
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12411
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: