Basic Information
| Provider Information | |||||||||
| NPI: | 1407388663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASSER | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 FARLEY RD | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040112642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077258079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6 FARLEY RD | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040112642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077258079 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2017 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD24610 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | VT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.