Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD18032 | ME |
Y | 208600000X | Surgeon | MD18032 | ME |
N | 2086X0206X | Surgical Oncologist | 15389 | SC |
NPI | 1194772061 |
---|---|
Provider Name | Dr. Brad Edward Waddell |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-6630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 28/02/2014 |