Provider Demographics
NPI:1366496804
Name:HENRY, WAYNE ANDRADE SR (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ANDRADE
Last Name:HENRY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5736
Mailing Address - Country:US
Mailing Address - Phone:207-626-1561
Mailing Address - Fax:207-626-1849
Practice Address - Street 1:15 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5736
Practice Address - Country:US
Practice Address - Phone:207-626-1561
Practice Address - Fax:207-626-1849
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011016-1363AS0400X
MEEC201008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical