Individual
DR. WAYNE A. MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 GREAT FALLS PLZ, SUITE 21, AUBURN, ME 04210-5966
(207) 333-4710
(207) 333-4715
Mailing address
PO BOX 1638, ALBANY, NY 12201-1638
(207) 777-7111
(207) 783-6660
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
011739
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001862
ANTHEM
—
01
—
010416156
TRAVELERS/CORE/MEDNET
—
01
—
015612
MEDICARE
—
01
—
0378600001
DMERC
—
01
—
100294000
USPS WC
—
01
—
1044480
AETNA
—
01
—
200009601
RR MEDICARE
—
01
—
201017
MEDICARE ASC FACILITY
—
01
—
270310099
MAINECARE
ME
01
—
D03588
HARVARD
—
01
—
DX4496
NEW MEDICARE PTAN
—
01
—
M4231
CIGNA
—
01
—
MM0716
MEDICARE CLINIC FACILITY
—
Enumeration date
06/15/2005
Last updated
07/12/2011
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