BRADFORD S. WAGNER (NPI# 1083848030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083848030 |
| Entity Type | Individual |
| Full Name | BRADFORD S. WAGNER |
| Credential | MD |
| Practice Address |
50 Foden Rd Ste 3 South Portland ME 04106-1718 |
| Mailing Address |
100 Gannett Dr Suite C South Portland ME 04106-5900 |
| Practice Telephone | 2078741489 |
| Practice Fax Number | 2075238590 |
| Mailing Telephone | 2078280361 |
| Mailing Fax Number | 2078741483 |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2020-10-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD19486 | ME | Allopathic & Osteopathic Physicians |
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
MD19486 | ME | Allopathic & Osteopathic Physicians |
| Street Address |
50 FODEN RD STE 3 |
| City | SOUTH PORTLAND |
| State | ME |
| Zip Code | 04106-1718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518073725 | Amy F. Parker | Emergency Medicine | 50 Foden Rd Ste 3, South Portland, ME 04106-1718 | 2006-08-21 |
| 1619042595 | Timothy Mcateer | Family Medicine | 50 Foden Rd Ste 3, South Portland, ME 04106-1718 | 2006-11-23 |
| 1447325816 | Mary H. Becker | Emergency Medicine | 50 Foden Rd Ste 3, South Portland, ME 04106-1718 | 2006-11-21 |
| 1679662563 | Allyson S. Howe | Family Medicine | 50 Foden Rd Ste 3, South Portland, ME 04106-1718 | 2006-10-11 |
| 1306931340 | William J. Ruth | Emergency Medicine | 50 Foden Rd Ste 3, South Portland, ME 04106-1718 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912513748 | Rayna Louise Sage | Behavior Technician | 50 Donald Beaver Drrive, Ste B, Portland, ME 04106 | 2020-09-17 |
| 1972127330 | Scott M Davis Md LLC | Internal Medicine | 89 Cannon Road, South Portland, ME 04106 | 2020-06-02 |
| 1568013936 | Clara Cassidy | Behavior Technician | 50 Donald Bean Dr, Ste B, South Portland, ME 04106 | 2019-09-26 |
| 1336614346 | Kari Whitney | Nurse Practitioner | Vna Home Health Hospice, 50 Foden Road, Suite 1, South Portland, ME 04106 | 2018-10-05 |
| 1588152193 | Kristen F. Pierce | Counselor | 100 Waterman Drive, Suite 201, South Portland, ME 04106 | 2018-04-30 |
| 1649779224 | Jennifer Rene Johnson | Social Worker | 135 Westbrook St, South Portland, ME 04106 | 2018-02-08 |
| 1154847721 | Integral Nutrition, LLC | Dietitian, Registered | 59 Baltimore Avenue, South Portland, ME 04106 | 2017-08-16 |
| 1730619610 | John Preston Powell | Psychiatry & Neurology | 68 B Street Apt 4, South Portland, ME 04106 | 2017-06-14 |
| 1649706268 | Gisselle Mani | Student in an Organized Health Care Education/Training Program | 30 Lydia Ln Apt 2115, South Portland, ME 04106 | 2017-05-02 |
| 1245786987 | Jonathan Frank Olmes | Optometrist | 335 Maine Mall Rd., South Portland, ME 04106 | 2016-09-01 |
| Find all providers in zip 04106 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295129393 | Oren Gersten | Family Medicine | 27 Ocean St Ste 3, South Portland, ME 04106-2854 | 2015-03-26 |
| 1548421878 | Elizabeth M Strawbridge | Family Medicine | 7 Cloyster Rd, South Portland, ME 04106-5111 | 2008-06-19 |
| 1558535559 | Mary J Connolly | Family Medicine | 100 Foden Road, East, Suite 203, South Portland, ME 04106-2327 | 2008-04-22 |
| 1285758953 | Asap Medical Clinics LLC | Family Medicine | 209 Western Ave, Suite B1-b2, South Portland, ME 04106 | 2007-03-19 |
| 1235249137 | Megan A. Staton | Family Medicine | 100 Foden Rd East, Suite 203, South Portland, ME 04106-2327 | 2006-08-30 |
| 1992730311 | Stephen Joseph Blair | Family Medicine | 400 Southborough Dr, South Portland, ME 04106-3249 | 2006-07-12 |
| 1205862760 | Michael Alexander Ciampi | Family Medicine | 380 Lincoln St., South Portland, ME 04106-3529 | 2006-06-24 |
| 1700824240 | Jeffrey M Saffer | Family Medicine | 51 Ocean St, South Portland, ME 04106-2828 | 2006-06-04 |
| 1952351223 | Matthew K Belcher | Family Medicine | 100 Foden Rd. East, South Portland, ME 04106 | 2006-05-10 |
| 1124016118 | Tara Kay Pelletier | Family Medicine | 100 Foden Road East, Suite 201, South Portland, ME 04106 | 2005-10-12 |
| Find all providers in SOUTH PORTLAND | ||||
| City | SOUTH PORTLAND |
| Zip Code | 04106 |
Please comment or provide details below to improve the information on BRADFORD S. WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.