Provider Demographics
NPI:1851316988
Name:WAINIO, MICHAEL DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:WAINIO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4727
Mailing Address - Country:US
Mailing Address - Phone:508-536-8461
Mailing Address - Fax:
Practice Address - Street 1:363 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-676-3411
Practice Address - Fax:508-235-6658
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006158-1363A00000X
MAPA2284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110186BFOtherPREFERRED CARE
NYP019006158OtherBLUE CHOICE
NY110186BFOtherPREFERRED CARE
NYPA0808Medicare ID - Type Unspecified