Bradford S. Wagner
Family Doctor Family Doctor - Sports Medicine
50 Foden Rd Ste 3
South Portland
, Maine 04106-1718
Bradford S. Wagner
Family Doctor Family Doctor - Sports Medicine
50 Foden Rd Ste 3
South Portland
, Maine 04106-1718
(207) 874-1483
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About
Features
Specialties
- Family Doctor
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Bradford S. Wagner
- 100 Gannett Dr Suite C
- South Portland, ME
- Zip : 04106-5900
- Fax : (207) 874-1483
- Phone : (207) 828-0361
Second Address
- Bradford S. Wagner
- 50 Foden Rd Ste 3
- South Portland, ME
- Zip : 04106-1718
- Fax : (207) 523-8590
- Phone : (207) 874-1489
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | MD19486 | ME |
| N | 207QS0010X | Family Doctor - Sports Medicine | MD19486 | ME |
National Provider Identifier
| NPI | 1083848030 |
|---|---|
| Provider Name | Bradford S. Wagner |
| First Address | South Portland, ME 04106-5900 |
| Second Address | South Portland, ME 04106-1718 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/05/2009 |
| Last Update Date | 01/10/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.