MEDICARE: DR. JOSEPH THOMAS WAYNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	220269	NY
2	207R00000X	Internal Medicine Physician	220269	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891782207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH THOMAS WAYNE M.D.

Provider Business Mailing Address
First Line	:	1019 NEW LOUDON RD
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-5003
Country	:	US
Telephone Number	:	518-262-7500
Fax Number	:	518-262-7505

Provider Business Practice Location Address
First Line	:	1019 NEW LOUDON RD
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-5003
Country	:	US
Telephone Number	:	518-262-7500
Fax Number	:	518-262-7505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	05/05/2021

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