Provider Demographics
NPI:1447224563
Name:TROTTER, WAYNE D (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:TROTTER
Suffix:
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 1:176 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2236
Mailing Address - Country:US
Mailing Address - Phone:508-634-5026
Mailing Address - Fax:508-634-5055
Practice Address - Street 1:176 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2236
Practice Address - Country:US
Practice Address - Phone:508-634-5026
Practice Address - Fax:508-634-5055
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1150381OtherFIRST HEALTH
5810227OtherAETNA
J12378OtherBLUE SHIELD HMO BLUE
J12378OtherBLUE CARE ELECT
3796007OtherCIGNA HEALTH PLAN
5810227OtherUS HEALTHCARE
AA1288OtherHARVARD PILGRIM HEALTHCAR
0401707OtherEVERCARE
042472266OtherHEALTHCARE VALUE MANAGEME
J12378OtherBLUE SHIELD INDEMNITY
042472266OtherONE HEALTH PLAN
MA110052123AMedicaid
26997OtherCHILDRENS MEDICAL SECURIT
784203OtherMVP HEALTH CARE
26997OtherHEALTHY START
3100995OtherWELFARE
9900289OtherFALLON COMMUNITY HEALTH P
MAJ1237801Medicare PIN