Provider Demographics
NPI:1033318753
Name:WINGARD, BRANDEI K (MD)
Entity Type:Individual
Prefix:
First Name:BRANDEI
Middle Name:K
Last Name:WINGARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-4281
Practice Address - Street 1:9 HEALTHCARE DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-282-3666
Practice Address - Fax:207-282-4281
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19215208M00000X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAA316117OtherHARVARD PILGRIM
ME7840316OtherCIGNA
ME1033318753OtherANTHEM
ME1033318753Medicaid
ME9221840OtherAETNA
ME002699701Medicare PIN
ME1033318753Medicaid
MEP01076941Medicare PIN