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General NPI Number Information
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NPI Number | 1114997970
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Entity Type | Individual
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Provider Name | WENDY GAINES MD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 9 HOPE AVE STE 151
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City | WALTHAM
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State | MA
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Zip | 02453-2741
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Country | US
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Telephone | 781-788-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 330 MT AUBURN ST PARSON 2
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5597
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Country | US
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Telephone | 617-499-5083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 150709
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License Number State | MA
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