Provider Demographics
NPI:1114997970
Name:GAINES, WENDY (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:GAINES
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 1:9 HOPE AVE
Mailing Address - Street 2:STE 151
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2741
Mailing Address - Country:US
Mailing Address - Phone:781-788-8444
Mailing Address - Fax:
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:STE 151
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2741
Practice Address - Country:US
Practice Address - Phone:781-788-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3161781Medicaid
MA3161781Medicaid
MAA21906Medicare ID - Type Unspecified