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Individual

DR. WAYNE ROBERT WATERMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
417 STATE ST, SUITE 221, BANGOR, ME 04401-6630
(207) 973-9949
(207) 973-9555
Mailing address
43 WHITING HILL RD, SUITE 300, BREWER, ME 04412-1005
(207) 973-5000
(207) 973-5042

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
DO2140
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1013050100001
PA
01
1092089
AETNA HMO
PA
01
1562320
CIGNA
PA
01
1736339
BLUE SHIELD
PA
01
2403288000
KEYSTONE HEALTH PLAN EAST
PA
01
30025514
KMHP
PA
01
7414717
AETNA PPO
PA
Enumeration date
07/14/2005
Last updated
04/22/2020
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