Provider Demographics
NPI:1851370068
Name:HAMILTON, WADE
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7634
Mailing Address - Country:US
Mailing Address - Phone:207-795-5730
Mailing Address - Fax:207-795-5749
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE 301
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7634
Practice Address - Country:US
Practice Address - Phone:207-795-5730
Practice Address - Fax:207-795-5749
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0130452080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME268990099Medicaid
ME268990099Medicaid
MEMM3863Medicare ID - Type Unspecified
MESX2131Medicare PIN