Basic Information
| Provider Information | |||||||||
| NPI: | 1891291183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WDPC ORTHOPEDICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23532 | ||||||||
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| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037404478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 MARSH BROOK DR | ||||||||
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| City: | SOMERSWORTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037422007 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | GAGNON | ||||||||
| AuthorizedOfficialFirstName: | TRISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. REVENUE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6037403205 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WENTWORTH DOUGLASS PHYSICIAN CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.