Basic Information
| Provider Information | |||||||||
| NPI: | 1033231105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WENDORF | ||||||||
| FirstName: | KIRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | YORK HOSPITAL | ||||||||
| Address2: | 15 HOSPITAL DR. | ||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073512398 | ||||||||
| FaxNumber: | 2073512411 | ||||||||
| Practice Location | |||||||||
| Address1: | YORK HOSPITAL | ||||||||
| Address2: | 15 HOSPITAL DR. | ||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073512398 | ||||||||
| FaxNumber: | 2073512411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A99656 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 017777 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00A996560 | 05 | CA | MEDICAID |