Individual
BRENDAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 BROADWAY, BANGOR, ME 04401-5201
(207) 947-0469
Mailing address
98 FOUNTAIN ST, BANGOR, ME 04401-3848
(613) 806-2243
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD25666
ME
Other
Enumeration date
08/08/2022
Last updated
08/08/2022
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